血浆microRNA-130a联合APACHE Ⅱ评分预测脓毒症伴血小板减少患者死亡的巢式病例对照研究

Prognostic value of serum microRNA-130a combined with APACHE Ⅱ score for predicting death in septic patients with thrombocytopenia

目的评价血浆microRNA-130a联合急性生理学与慢性健康状况评估Ⅱ(APACHEⅡ)评分对脓毒症伴血小板减少患者死亡的预测价值.方法选取2017年7月至2019年7月江苏大学附属医院收治的52例脓毒症伴血小板减少患者为研究对象进行前瞻性巢式病例对照研究,其中男性30例,女性22例;年龄33~79岁,平均(62.81±11.48)岁.记录患者入院时的基线资料、APACHEⅡ评分,并留取所有患者入院24 h内的血浆标本-20℃保存备用.将研究过程中发生死亡的患者列为死亡组,同时以患者年龄、性别、发病时间和原发感染部位等基线信息作为匹配条件,按照1:1从同队列中匹配生存患者作为对照组.比较两组患者血浆microRNA-130a表达量和APACHEⅡ评分的差异,并利用Pearson相关检验分析二者的相关性.利用受试者工作特征曲线(ROC)及ROC曲线下面积(AUC)评价血浆microRNA-130a表达量联合APACHEⅡ评分对脓毒症伴血小板减少患者死亡的预测价值.结果共纳入42例脓毒症伴血小板减少患者进行分析,死亡组、对照组每组各21例,两组患者的基线资料具有可比性.与对照组相比,死亡组患者血浆microRNA-130a表达量[(0.95±0.15)分比(0.80±0.29)分]显著降低,APACHEⅡ评分[(19.38±3.63)分比(22.52±4.70)分]显著增高,差异有统计学意义(P均<0.05).相关分结果提示,死亡组患者血浆MicroRNA-130a表达量与APACHEⅡ评分呈负性强相关(r=-0.750,P<0.05).ROC曲线分析提示:血浆microRNA-130a测定联合APACHEⅡ评分的患者死亡预测价值[AUC=0.71,95%置信区间(CI):0.54~0.89]高于二者独立预测(microRNA-130a:AUC=0.688,95%CI:0.52~0.86.APACHEⅡ评分:AUC=0.694,95%CI:0.53~0.86.P均<0.05)].结论血浆microRNA-130a表达量降低与脓毒症伴血小板减少症患者死亡密切相关,血浆microRNA-130a测定联合APACHEⅡ评分对脓毒症伴血小板减少患者的死亡有较好预测价值.

Objective To evaluate the prognostic value of serum microRNA-130 a combined with acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score for predicting death in septic patients with thrombocytopenia. Methods This nested case-control study was performed from July 2017 to July 2019. A total of 52 septic patients with thrombocytopenia who were diagnosed in the Affiliated Hospital of Jiangsu University were included. There were 30 males and 22 females. The age ranged from 33 to 79 years, with an average age of(62.81 ± 11.48) years. The age rangedAPACHE Ⅱ score were recorded. Plasma samples of all patients within 24 h after admission were collected and stored at-20℃ for later use. The definite diagnosis of sepsis in hospital was defined as the starting point for participating, and death was defined as the end point for terminating participation. Patients who died during the study period were defined as the death group. Meanwhile, the age, sex, onset time, primary infection site and other basic information of the children were used as matching conditions, and the non-dead children were randomly selected from the same cohort as the control group in 1:1. Differences of serum microRNA-130 a expression and APACHE Ⅱ score in two groups were compared. Pearson correlation analysis was used to analyze the correlation between the serum miR-130 a expression and APACHE Ⅱ score in septic patients with thrombocytopenia. Receiver operator characteristic(ROC) curve analysis was used to analyze the value of microRNA-130 a and APACHE Ⅱ score in predicting the death of septic patients with thrombocytopenia. Results According to the design, a total of 42 septic patients with thrombocytopenia(21 in the death group and 21 in the control group) were selected as the final participants. Baseline data were comparable between the two groups. Compared with the control group, the expression of microRNA-130 a [(0.95±0.15) vs.(0.80±0.29)] was significantly lower, and the APACHE Ⅱ score [(19.38±3.63) vs.(22.52±4.70)] was significantly higher in the death group(P<0.05). The correlation analysis showed that the expression of serum miR-130 a was negatively correlated with APACHE Ⅱ score(r=-0.750,P<0.05) in death septic patients with thrombocytopenia. ROC curve analysis indicated that the prognostic value of microRNA-130 a combined with APACHE Ⅱ score [(the area under the ROC curve(AUC) =0.71, 95% confidence interval(95% CI): 0.54~0.89)] was of higher than the single microRNA-130 a [(AUC=0.688, 95%CI: 0.52 ~ 0.86)], and APACHE Ⅱ score [(AUC=0.694,95%CI:0.53 ~ 0.86)]. Conclusions Decreased serum microRNA-130 a expression level is closely associated with mortality of septic patients with thrombocytopenia;microRNA-130 a combination with APACHE Ⅱ score has a good predictive value for the death of septic patients with thrombocytopenia.