摘要
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.
作者
李大勇
戴瑶
刘冠兰
郭宁
童国相
Li Da-yong;Dai Yao;Liu Guan-lan;Guo Ning;Tong Guo-xiang(Department of Critical Care Medicine,First Hospital of Changsha,Changsha 410005,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2018年第10期863-868,I0001,共7页
Chinese Journal of Critical Care Medicine