血清淀粉样蛋白A、白介素6、肿瘤坏死因子α及微小RNA在脓毒症并发急性肾损伤患儿中的表达及预后评估价值研究

Expression and Prognostic Value of Serum SAA,IL-6,TNF-α and microRNAs in Children with Sepsis Complicated with Acute Kidney Injury

背景 急性肾损伤(AKI)是脓毒症常见并发症,机体免疫-炎症指标是预测脓毒症并发AKI患儿预后的常用指标,目前从微小RNA(miR)方面评估的研究较少,有待临床探究。目的 探究血清淀粉样蛋白A(SAA)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)及miR在脓毒症并发AKI患儿中的表达,并分析其对预后的评估价值。方法 选取2020年3月—2023年3月平顶山市第一人民医院收治的100例脓毒症并发AKI患儿为观察组,另选取同期80例单纯脓毒症患儿为对照组。收集患者一般资料,酶联免疫吸附试验(ELISA)检测血清SAA、IL-6、TNF-α水平,采用实时荧光定量PCR法检测miR-21-3p、miR-182-5p、miR-128-3p相对表达量。比较两组序贯性器官功能衰竭(SOFA)评分、急性生理与慢性健康(APACHEⅡ)评分。采用Pearson相关性检验分析血清SAA、IL-6、TNF-α及miR水平与SOFA、APACHEⅡ评分的相关性。绘制受试者工作特征(ROC)曲线探究血清SAA、IL-6、TNF-α及miR水平对脓毒症并发AKI患儿死亡的预测价值并计算ROC曲线下面积(AUC)。结果 观察组SOFA评分、APACHEⅡ评分、血清SAA、IL-6、TNF-α、miR-21-3p、miR-182-5p、miR-128-3p水平均高于对照组(P<0.05)。住院28 d后观察组74例患儿生存,26例患儿死亡。生存患儿血清SAA、IL-6、TNF-α、miR-21-3p、miR-182-5p、miR-128-3p均低于死亡患儿(P<0.05)。血清SAA、IL-6、TNF-α、miR-21-3p、miR-182-5p、miR-128-3p与SOFA、APACHEⅡ评分均呈正相关(P<0.05)。ROC曲线结果显示联合预测的AUC为0.926(95%CI=0.856~0.969,P<0.05)。结论 脓毒症并发AKI患儿血清SAA、IL-6、TNF-α、miR-21-3p、miR-182-5p、miR-128-3p异常高表达,临床检测各项指标水平对患儿预后评估有较高价值及预警作用。

Background Acute kidney injury(AKI)is a common complication of sepsis.Immune-inflammatory markers are commonly used to assess the prognosis of these patients.However,studies evaluating microRNAs(miR)in this context are scarce,indicating a need for further clinical investigation.Objective To investigate the expression of serum amyloid A(SAA),interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),and miR in pediatric patients with sepsis-induced AKI and analyze their prognostic assessment value.Methods This study included 100 pediatric patients with sepsis-induced AKI admitted to the First People's Hospital of Pingdingshan from March 2020 to March 2023 as the observation group,and 80 pediatric patients with sepsis alone as the control group.General patient data were collected,and serum levels of SAA,IL-6,and TNF-αwere measured using enzyme-linked immunosorbent assay(ELISA).The relative expression of miR-21-3p,miR-182-5p,and miR-128-3p was quantified using real-time quantitative PCR.The Sequential Organ Failure Assessment(SOFA)score and the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score were compared between the groups.Pearson correlation analysis was used to evaluate the relationship between the levels of serum SAA,IL-6,TNF-α,and miRs and the SOFA and APACHEⅡscores.Receiver operating characteristic(ROC)curves were plotted to explore the predictive value of these markers for mortality in pediatric patients with sepsis-induced AKI and to calculate the area under the ROC curve(AUC).Results The observation group showed significantly higher SOFA scores,APACHEⅡscores,and levels of serum SAA,IL-6,TNF-α,miR-21-3p,miR-182-5p,and miR-128-3p compared to the control group(P<0.05).After 28 days of hospitalization,74 patients in the observation group survived,while 26 died.Surviving patients had lower levels of serum SAA,IL-6,TNF-α,miR-21-3p,miR-182-5p,and miR-128-3p compared to those who died(P<0.05).Levels of serum SAA,IL-6,TNF-α,miR-21-3p,miR-182-5p,and miR-128-3p were positively correlated with SOFA and APACHEⅡscores(P<0.05).ROC curve results showed a combined predictive AUC of 0.926(95%CI=0.856-0.969,P<0.05).Conclusion The serum levels of SAA,IL-6,TNF-α,miR-21-3p,miR-182-5p,miR-128-3p are abnormally high in children with sepsis complicated with AKI.Clinical detection of these indicators has a high value and early warning effect on the prognosis of children.