miR-20a-5p对脓毒症患者急性肾损伤的早期诊断价值

The early diagnostic value of miR - 20a - 5p on acute kidney injury in patients with sepsis

目的筛选与脓毒症合并急性肾损伤（AKI）相关的循环血miRNAs，并探讨其对脓毒症患者发生AKI的早期诊断价值。方法2016-09-2018-01期间在长沙市第-医院重症医学科住院的脓毒症患者82例，确诊后7d内，43例患者发生AKI（脓毒症＋AKI组），其余39例患者未合并AKI（脓毒症组）。采集静脉血，采用基因芯片技术筛选两组患者有表达差异的miRNAs，并进行qRT-PCR验证，比较两组患者（AKI确诊前1天和当日，未发生AKI患者人院第3天）血液生化指标、凝血指标、APACHEⅡ评分、qSOFA评分的差异。结果①脓毒症＋AKI组患者确诊当日肝功能、肾功能、凝血功能指标、APACHEⅡ评分、qSOFA评分与脓毒症组患者（入院后3d）比较，差异均有统计学意义（P〈0．05）。②脓毒症＋AKI组患者确诊前1天肾小球滤过率（GFR）与脓毒症组患者（入院后3d）比较，差异有统计学意义（P〈0．05）。③经基因芯片分析以及qRT-PCR检测，脓毒症＋AKI组患者（AKI确诊前1天）外周血miR-20a-5p表达水平明显高于脓毒症组患者（入院后3d）（P〈0．05）。④经Logistic回归分析，miR-20a-5p水平升高是发生AKI的独立危险因素（P〈0．05）。⑤经ROC曲线分析，外周血miR-20a-5p诊断ROC的曲线下面积为0．923。结论脓毒症患者循环血miR-20a-5p表达水平可作为AKI发生的早期预测因子，具有较高的诊断效能。

Objective To screen peripheral blood miRNAs related with acute kidney injury （AKI） in patients with sepsis ; and to investigate the early diagnostic value of miRNAs on sepsis - AKI. Methods 82 patients with sepsis in our hospital were selected from September 2016 to January 2018 and divided into patients with sepsis combined with AKI （sepsis - AKI group, n = 43 ） and patients without AKI group （ sepsis group, n = 39 ）. Serum miRNA expression profiles were determined in blood samples from sepsis patients （ after admission of 3 d） and sepsis - AKI patients （ on diagnosis day or before 1 d）. The levels of plasma miRNAs, biochemistry indexes, APACHEⅡ scores and qSOFA scores were detected and compared between the two groups. Results ①There was statistical difference of the baseline values of liver and kidney function indexes, APACHEⅡ scores and qSOFA scores between sepsis group （after admission of 3 d） and sepsis- AKI group（ on diagnosis day） （P 〈 0.05 ）.②Theglomerlar filtration rate （GFR） of sepsis - AKI patients before diagnosis of 1 d were lower than seps＇s patients without AKI （after admission of 3d） （P 〈 0.05 ）. ③The serum miR -20a- 5p expression levelsin peripheral blood of sepsis - AKI patients before diagnosis of 1 d were higher than sepsis patients without AKI （after admission of 3 d） （P 〈 0.05 ）. ④The high miR - 20a - 5p expression was an independent risk factor of AKI in sepsis patients （ P 〈 0.05 ）. ⑤The AUC of ROC curve of miR - 20a - 5p was 0. 923. Conclusion It suggested that miR - 20a - 5p is a sensitive predictor of acute kidney injury in patients with sepsis.