循环miR-192对心脏手术后急性肾损伤的早期诊断作用

Effect of circulating miR-192 on early diagnosis of acute kidney injury after cardiac surgery

目的探讨循环miR-192在成人心脏手术后急性肾损伤（AKI）早期诊断中的价值。方法前瞻性收集心脏手术患者手术前后不同时相的血标本,选取心脏手术后AKI患者35例以及临床资料相匹配的非AKI患者35例检测,分别测定血清肌酐（Scr）和血浆miR-192水平。观察两组患者围手术期miR-192与Scr的动态变化。用受试者工作特征曲线及曲线下面积（AUC）评价miR-192诊断AKI的精确性。AKI定义为48 h内Scr水平增加≥0.3 mg/d L或增至基线值的1.5倍以上。结果 70例患者平均年龄（64.31±8.17）岁,基础Scr（74.97±16.25）μmol/L。AKI组中应用Scr诊断AKI的中位时间为入ICU后24 h。术前两组患者的血浆miR-192水平无显著差异,而术后入ICU即刻两组患者的miR-192水平均较术前显著升高[分别为1.12（0.47,2.42）与1.93（0.93,3.24）,0.79（0.41,1.16）与1.65（0.97,2.36）,P均〈0.05],其中AKI组患者的miR-192水平更高,但两组相比,差异无统计学意义;术后2 h AKI组患者的血浆miR-192水平持续升高,而非AKI组患者开始下降,两组差异存在统计学意义[1.80（0.94,5.10）与1.21（0.88,1.77）,P〈0.05],此时血浆miR-192诊断AKI的AUC=0.67（95%CI 0.54-0.81,P=0.01）。结论血浆miR-192水平在心脏手术后AKI患者术后早期即显著升高,术后2 h患者循环中的miR-192水平可能可以作为成人心脏手术后AKI的早期诊断标志物。

Objective To investigate the value of circulating miR-192 in early diagnosis of acute kidney injury （AKI） after cardiac surgery. Methods Blood samples were prospectively collected at different time points before and after cardiac surgery. After cardiac surgery, serum creatinine （Scr） and miR-192 levels of 35 patients with AKI and 35 patients without AKI whose clinical data were similar to patients with AKI were detected. Dynamic changes of mLR-192 and Scr levels of two groups during the perioperative period were observed. Receiver operating characteristic （ROC） curves and areas under curves （AUC） were used to evaluate the precision of diagnosing AKI by miR-192. AKI was defined as the increase of Scr level was above 0.3mg/dL or 1.5 times of baseline value within 48 h after surgery. Results The mean age of 70 patients was （ 64. 31 ＋ 8.17） and the baseline Scr level was （74. 97 _＋ 16.25） ～rnol/L. The median time of diagnosing AKI by Scr of the AKI group was 24 h after admission in ICU. There was no significant difference in the level of plasma miR-192 between two groups before surgery. Compared with levels of plasma miR-192 of two groups before surgery, levels of plasma miR-192 after surgery immediately increased [ 1.12 （0.47, 2.42） vs 1.93 （0.93, 3.24） and 0.79 （0.41, 1.16） vs 1.65 （0.97, 2.36） for patients with AKI and without AKI, P〈0.05]. Levels of plasma miR-192 of the AKI group were higher, but the difference of two groups was not statistically significant. The level of plasma miR-192 of the AKI group 2 h after surgery continuously increased, while that of the non-AKI group began to decrease. The difference of two groups was statistically significant [1.80 （0.94, 5.10） vs 1.21 （0.88, 1.77）, P 〈0.05]. AUC for diagnosing AKI by plasma miR-192 was 0.67 （95% CI 0. 54 -0.81, P=0.01）. Conclusion The level of plasma miR-192 of patients with AKI significantly increases at early stage after cardiac surgery and the level of circulating miR-192 2 h after surgery can be used as a biomarker for early diagnosis of AKI after cardiac surgery.