脓毒症合并AKI患者血清miR-494表达及其临床意义

Expression of serum miR-494 in patients with sepsis complicated with AKI and its clinical significance

目的探讨脓毒症合并急性肾损伤(AKI)患者血清miR-494表达与肾功能、外周血辅助性T细胞17(Th17)细胞的相关性,分析影响脓毒症合并AKI患者预后的因素。方法选择2018年1月-2020年3月贵州盘江投资控股(集团)有限公司总医院收治的85例脓毒症合并AKI患者(AKI组),122例脓毒症未合并AKI患者(NAKI组),另选择132名健康志愿者为对照组。检测血清miR-494、血清尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率(e GFR)水平和外周血Th17细胞占比,分析其相关性。使用logistic回归分析影响脓毒症合并AKI患者预后的危险因素。结果AKI组血清miR-494、BUN、Scr水平、外周血Th17细胞占比高于NAKI组和对照组,eGFR低于NAKI组和对照组,差异均有统计学意义(P均<0.01)。AKI组患者血清miR-494表达水平与BUN、Scr、外周血Th17细胞占比成正相关(r=0.689、0.641、0.652,P均<0.01),与eGFR成负相关(r=-0.633,P<0.001)。AKI患者死亡23例,存活62例。AKI分期为3期、应用血管活性药物、肾外器官衰竭、高miR-494表达是脓毒症合并AKI患者入院28 d内死亡的危险因素(P均<0.05)。结论脓毒症合并AKI患者血清miR-494表达明显升高,miR-494高表达与肾功能下降和Th17细胞占比增加有关,是脓毒症合并AKI患者入院28 d内死亡的危险因素。

Objective To investigate the correlation of serum microRNA(miR-494)expression with renal function and helper T cell 17(Th17)cells in patients with sepsis complicated with acute kidney injury(AKI),and analyze the factors influencing the prognosis of patients with sepsis complicated with AKI.Methods A total of 85 patients with sepsis complicated with AKI(AKI group),122 patients without AKI(NAKI group)who were admitted to general hospital of Guizhou panjiang investment holding(Group)Co.,Ltd from January 2018 to March 2020 were selected,and 132 healthy volunteers as control group.The serum expression of miR-494,levels of blood urea nitrogen(BUN),serum creatinine(Scr),estimated glomerular filtration rate(eGFR)and Th17 cells were detected,and the correlation between above index were analyzed.Clinical data was collected and the risk factors influencing the prognosis of patients with sepsis and AKI were analyzed by logistic regression.Results The levels of miR-494,BUN and Scr in AKI group were higher than those in NAKI group and control group,and eGFR was lower than those in NAKI group and control group(P<0.05).In AKI group,the expression of miR-494 was positively correlated with BUN,Scr and the proportion of Th17 cells in peripheral blood(r=0.689,0.641,0.652,all P<0.001),and negatively correlated with eGFR(r=-0.633,P<0.001).Among 85 patients with sepsis and AKI,23 died and 62 survived.AKI stage 3,application of vasoactive drugs,extrarenal organ failure and high expression of miR-494 were risk factors for death within 28 days after admission.Conclusion The expression of miR-494in patients with sepsis and AKI was significantly increased,and the high expression of miR-494 was related to the decline of renal function and the increased proportion of Th17 cells,which could be a risk factor for death in patients with sepsis and AKI within 28 days after admission.