血清微小RNA-155-5p对脓毒症急性肝损伤患者预后的评估价值分析

Predictive value of serum microRNA-155-5p on prognosis in sepsis patients with acute liver injury

目的探讨血清微小RNA(miR)-155-5p对脓毒症急性肝损伤患者预后的评估价值。方法回顾性分析2017年3月至2019年3月浙江省荣军医院103例脓毒症急性肝损伤患者的临床资料。其中,治疗好转57例(存活组),院内死亡46例(死亡组)。比较两组患者临床资料及血清miR-155-5p,分析影响脓毒症急性肝损伤患者预后的相关危险因素,并采用受试者工作特征(ROC)曲线分析miR-155-5p对患者预后的评估价值。结果死亡组脓毒症休克发生率、年龄、降钙素原(PCT)、C反应蛋白(CRP)、D-二聚体、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)和miR-155-5p均明显高于存活组[95.65%(44/46)比45.61%(26/57)、(50.82±10.52)岁比(43.84±7.32)岁、(16.42±4.97)μg/L比(7.20±2.19)μg/L、(23.21±8.59)mg/L比(16.73±5.04)mg/L、(10.84±3.17)mg/L比(4.16±2.15)mg/L、(22.37±3.16)分比(16.72±4.10)分、(10.98±3.74)分比(6.84±2.47)分和3.10±0.97比2.25±0.63],差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,APACHEⅡ、SOFA、PCT和miR-155-5p是影响脓毒症急性肝损伤患者预后的独立危险因素(OR=3.173、2.732、2.553和2.153,95%CI 2.127~6.312、2.018~6.056、1.249~4.466和1.234~4.153,P<0.01或<0.05)。ROC曲线分析结果显示,miR-155-5p最佳截断值为2.89时,评估脓毒症急性肝损伤患者预后的曲线下面积为0.871(95%CI 0.782~0.951),敏感度为86.1%,特异度为80.4%。结论血清miR-155-5p与脓毒症急性肝损伤患者临床预后密切相关,可作为患者预后评估的潜在指标之一。

Objective To explore the predictive value of serum microRNA(miR)-155-5p on prognosis in sepsis patients with acute liver injury.Methods The clinical data of 103 sepsis patients with acute liver injury from March 2017 to March 2019 in Rongjun Hospital,Zhejiang Province,were retrospectively analyzed.Among them,57 patients were improved(survival group)and 46 patients died in hospital(death group).The clinical data and serum miR-155-5p were compared between 2 groups,and the influencing factors of prognosis in sepsis patients with acute liver injury were analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the prognosis value of miR-155-5p.Results The incidence of septic shock,age,procalcitonin(PCT),C-reactive protein(CRP),D-dimer,acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure score(SOFA)and miR-155-5p in death group were significantly higher than those in survival group:95.65%(44/46)vs.45.61%(26/57),(50.82±10.52)years vs.(43.84±7.32)years,(16.42±4.97)μg/L vs.(7.20±2.19)μg/L,(23.21±8.59)mg/L vs.(16.73±5.04)mg/L,(10.84±3.17)mg/L vs.(4.16±2.15)mg/L,(22.37±3.16)scores vs.(16.72±4.10)scores,(10.98±3.74)scores vs.(6.84±2.47)scores and 3.10±0.97 vs.2.25±0.63,and there were statistical differences(P<0.05).Multivariate Logistic regression analysis result showed that the APACHEⅡ,SOFA,PCT and miR-155-5p were the independent risk factors of prognosis in sepsis patients with acute liver injury(OR=3.173,2.732,2.553 and 2.153;95%CI 2.127 to 6.312,2.018 to 6.056,1.249 to 4.466 and 1.234 to 4.153;P<0.01 or<0.05).ROC curve analysis result showed that the cut-off value of miR-155-5p was 2.89,and the area under curve was 0.871(95%CI 0.782 to 0.951),with a sensitivity of 86.1%and a specificity of 80.4%.Conclusions Serum miR-155-5p is closely related to the clinical prognosis in sepsis patients with acute liver injury.It can be used as one of the potential prognostic indicators for patients,and is worthy of further clinical study and analysis.