血清miRNA-122a和降钙素原对脓毒症相关肝损伤早期诊断及预后评估的临床价值

Clinical value of serum miRNA-122a and PCT in the early diagnosis and prognosis of sepsis-related liver injury

目的探讨miRNA-122a、降钙素原(procalcitonin,PCT)对脓毒症相关肝损伤(sepsis related liver injury,SRLI)的早期诊断及预后评估的临床价值。方法选择152例脓毒症相关肝损伤的患者和同期46例脓毒症患者作为研究对象。脓毒症相关肝损伤组按肝损伤程度分为轻度、中度、重度肝损伤组。选择健康体检者40例作为对照组。分析两组患者的临床资料,采用RT-PCR测定血清miRNA-122a表达量。采用受试者工作特征ROC曲线分析miRNA-122a、PCT对脓毒症相关肝损伤的早期诊断价值。采用二元Logistic回归分析影响脓毒症相关肝损伤患者预后的危险因素。结果(1)与对照组比较,脓毒症组和肝损伤组患者的血清PCT浓度、miRNA-122a的表达量明显升高,差异有统计学意义(P<0.01)。ROC曲线分析显示,血清miRNA-122a、PCT诊断脓毒症相关肝损伤的AUC分别为:0.788(95%CI:0.695~0.863)、0.756(95%CI:0.693~0.832),当两者联合时AUC为0.868(95%CI:0.786~0.928)。(2)肝损伤三组患者血清miRNA-122a、PCT比较,差异有统计学意义,肝损伤组血清miRNA-122a、PCT显著高于无肝损组(P<0.01)。(3)二元Logistic回归分析发现,肝损伤严重程度、APACHE II评分、SOFA评分、miRNA-122a是影响脓毒症相关肝损伤患者预后的独立危险因素。结论血清miRNA-122a联合PCT检测对评估脓毒症相关肝损伤具有较高的敏感度和特异度,且miRNA-122a对脓毒症相关肝损伤患者预后评估有一定的临床价值。

Objective To investigate the clinical significance of miRNA-122 a and procalcitonin(PCT)in early diagnosis and prognosis of sepsis related liver injury(SRLI).Methods A total of 152 sepsis patients were selected as the research subjects.According to the occurrence of acute liver injury,they were divided into the liver injury group and the non-liver injury group.Sepsis related liver injury group was divided into mild liver injury group,moderate liver injury group and severe liver injury group according to the degree of liver injury.Forty healthy individuals were selected as controls.The expressions of miRNA-122 a in serum were determined by reverse transcriptase polymerase chain reaction(RT-PCR).Receiver operation characteristic curve(ROC)was used to evaluate the value of miRNA-122 a and PCT for the diagnosis sepsis related liver injury.Binary logistic regression was used to analyze the prognostic risk factors of sepsis related liver injury patients.Results(1)Compared with the control group,PCT concentration and miRNA-122 a expression level of patients in the sepsis group and sepsisrelated liver injury group were significantly increased,with statistically significant differences(P<0.01).ROC curve analysis showed that the AUC of serum miRNA-122 a and PCT for the diagnosis of sepsis related liver injury were:0.788(95%CI:0.695~0.863)and 0.756(95%CI:0.693~0.832).When miRNA-122 a combined with PCT for the diagnosis of sepsis-related liver injury was 0.868(95%CI:0.786~0.928).(2)The expression levels of miRNA-122 a and PCT in serum of liver injury groups were all higher than those in the no-liver injury group(P<0.01).3.Binary logistic regression analysis found that the severity of liver injury,APACHE II score,SOFA score and miRNA-122 a were independent risk factors affecting the prognosis of patients with sepsis related liver injury.Conclusions Serum miRNA-122 a combined with PCT test has high sensitivity and specificity in the evaluation of sepsis related liver injury,and miRNA-122 a has certain clinical value in the evaluation of prognosis of patients with sepsis related liver injury.