脓毒症患者血清miR-205和HMGB1的表达关系及意义

Relationship between expressions of miR-205 and HMGB1 in serum of patients with sepsis and its significance

目的:检测脓毒症患者血清miR-205、高迁移率族蛋白B1(HMGB1)的表达水平,并探讨二者在脓毒症中的关系及意义。方法:随机选取2017-03-12-2019-09-20期间于本院就诊的55例脓毒症患者为观察组,根据患者21 d时的生存情况分为存活组和死亡组,同期选取于本院进行体检的50例健康人群为对照组,采用qRT-PCR法检测各组血清miR-205水平,采用酶联免疫吸附(ELISA)法检测血清中HMGB1的表达水平,采用Pearson法分析血清miR-205、HMGB1水平与反映疾病严重程度的急性生理学和慢性健康评分Ⅱ(APACHEⅡ)评分、多器官功能障碍综合征(MODS)评分的相关性,采用ROC曲线分析血清miR-205、HMGB1及APACHEⅡ评分对脓毒症患者不良预后的预测价值。结果:观察组血清miR-205表达水平显著低于对照组,血清HMGB1水平显著高于对照组(P<0.05);死亡组APACHEⅡ评分、MODS评分及血清HMGB1水平均显著高于存活组,血清miR-205水平显著低于存活组(P<0.05);Pearson法分析结果显示,脓毒症患者血清miR-205与HMGB1、APACHEⅡ评分均呈负相关(P<0.05),HMGB1与APACHEⅡ评分呈正相关(P<0.05),血清miR-205、HMGB1与MODS评分均无相关性(P>0.05);ROC曲线分析结果显示,血清miR-205预测脓毒症患者不良预后的曲线下面积为0.851,敏感度为67.30%,特异度为92.00%;血清HMGB1预测不良预后的曲线下面积为0.888,敏感度为76.40%,特异度为94.00%;APACHEⅡ评分预测不良预后的曲线下面积为0.908,敏感度为83.30%,特异度为88.90%。结论:脓毒症患者血清miR-205水平降低,血清HMGB1水平升高,对患者不良预后有一定预测价值。

Objective: To detect the expression levels of miR-205 and high mobility group protein B1(HMGB1) in serum of patients with sepsis, and to explore their relationship and significance in sepsis. Method: A total of 55 patients with sepsis who were treated in our hospital from March 2017 to September 2019 were enrolled in the observation group, and 50 healthy people having physical examination in our hospital at the same time were enrolled in the control group. According to the survival condition of patients at the 21 st day after hospitalization, they were divided into survival group and death group. The serum miR-205 level was detected by qRT-PCR. Enzyme linked immunosorbent assay(ELISA) was used to detect the expression level of HMGB1 in serum. Pearson method was used to analyze the correlations between serum miR-205, HMGB1 levels and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), multiple organ dysfunction syndrome(MODS) scores. Logistic regression was used to analyze the influencing factors of miR-205 and HMGB1 over the survivalor death of patients with sepsis, and ROC curve was used to analyze the predictive values of serum miR-205 and HMGB1 for the prognosis of sepsis. Result: The expression level of serum miR-205 in the observation group was significantly lower than that in the control group, and the level of HMGB1 was significantly higher than that in the control group(P<0.05). The level of miR-205 in the survival group was significantly higher than that in the death group, and the level of HMGB1 was significantly lower than that in the death group. Pearson analysis showed that the serum miR-205 level was negatively correlated with the HMGB1 level and APACHE Ⅱ, the HMGB1 level was positively correlated with APACHE Ⅱ(P<0.05), and the miR-205 and HMGB1 levels were not correlated with MODS score(P>0.05). ROC curve analysis showed that the areas under curve(AUC) of miR-205 and HMGB1 predicting adverse prognosis in sepsis were 0.851 and 0.888 respectively, the AUC of the two combination predicting adverse prognosis in sepsis were 0.927, and the sensitivity and specificity were 74.5% and 98% respectively. The results of logistic regression analysis showed that serum miR-205 and HMGB1 levels were independent risk factors of septic death(P<0.05). Conclusion: The decreasing of serum miR-205 level and increasing of HMGB1 level have certain predictive values for poor prognosis of sepsis. They are independent risk factors for the adverse prognosis of patients with sepsis.