血清miR-182-5p表达水平对脓毒症患儿继发急性肾损伤的早期预测价值

Early predictive value of levels of miR-182-5p in serum in children with sepsis secondary to acute kidney injury

目的:探讨血清miR-182-5p表达对脓毒症患儿继发急性肾损伤(AKI)的早期预测价值。方法:选取2016年1月~2019年6月海南省第三人民医院收治的脓毒症患儿196例,分为继发AKI组(AKI组,n=72)和未继发AKI组(非AKI组,n=124),检测两组血清miR-182-5p、血肌酐(Scr)、胱抑素C(Cys-C)及肾损伤分子-1(KIM-1)水平。应用多因素Logistic回归分析脓毒症患儿继发AKI的危险因素。绘制ROC曲线分析血清miR-182-5p、Scr、Cys-C及KIM-1水平对AKI的早期预测价值,Pearson相关分析检测血清miR-182-5p表达水平与Scr、Cys-C及KIM-1的相关性。结果:AKI组血清miR-182-5p(1.46±0.62 vs 0.35±0.08)、Scr(460.28±84.26 vs 90.42±10.35,μmol/L)、Cys-C(1.83±0.57 vs 0.58±0.12,mg/L)及KIM-1(22.90±6.35 vs 4.75±0.62,μg/L)水平明显高于非AKI组(P<0.05)。多因素Logistic回归分析发现血清miR-182-5p(OR=2.903,95%CI:1.870~5.116)、Scr(OR=1.704,95%CI:1.105~2.940)、Cys-C(OR=2.063,95%CI:1.434~3.970)及KIM-1(OR=2.530,95%CI:1.524~4.613)水平升高是脓毒症患儿继发AKI的独立危险因素(P<0.05)。ROC曲线分析显示,血清miR-182-5p、Scr、Cys-C及KIM-1水平四项联合预测脓毒症患儿继发AKI的曲线下面积(0.956,95%CI:0.903~0.997)最大,其敏感度和特异度较高,为96.4%和90.8%。Pearson相关分析显示,AKI组血清miR-182-5p表达水平与Scr、Cys-C及KIM-1均呈正相关(r=0.683、r=0.795、r=0.847,P<0.01)。结论:血清miR-182-5p表达水平在脓毒症患儿继发AKI中明显升高,是脓毒症患儿继发AKI的独立危险因素,联合Scr、Cys-C及KIM-1水平对预测AKI具有较高的价值。

Objective:To explore the early predictive value of expressions of serum miR-182-5p for secondary acute kidney injury(AKI)in children with sepsis.Methods:196 children with sepsis who admitted to the Third People′s Hospital of Hainan Province from January 2016 to June 2019 were selected,and divided into secondary AKI group(AKI group,n=72)and non-secondary AKI group(non-AKI group,n=124).Serum levels of miR-182-5p,serum creatinine(Scr),cystatin C(Cys-C)and kidney injury molecule-1(KIM-1)were measured in the two groups.Multivariate Logistic regression was used to detect risk factors of secondary AKI in children with sepsis.ROC curve was drawn to detect the early predictive value of serum levels of miR-182-5p,Scr,Cys-C and KIM-1 for AKI.Pearson correlation analysis were used to detect the correlation between serum levels of miR-182-5p and Scr,Cys-C and KIM-1.Results:Serum levels of miR-182-5p(1.46±0.62 vs 0.35±0.08),Scr[(460.28±84.26)vs(90.42±10.35)μmol/L],Cys-C[(1.83±0.57)vs(0.58±0.12)mg/L]and KIM-1[(22.90±6.35)vs(4.75±0.62)μg/L]in AKI group were significantly higher than those in non-AKI group(P<0.05).Multivariate Logistic regression analysis showed that elevated levels of serum miR-182-5p(OR=2.903,95%CI:1.870-5.116),Scr(OR=1.704,95%CI:1.105-2.940),Cys-C(OR=2.063,95%CI:1.434-3.970)and KIM-1(OR=2.530,95%CI:1.524-4.613)were independent risk factors for secondary AKI in children with sepsis(P<0.05).ROC curve analysis showed that the area under the curve(0.956,95%CI:0.903-0.997)of serum miR-182-5p,Scr,Cys-C and KIM-1 levels 4 joints combined to predict secondary AKI in children with sepsis were the largest,with high sensitivity and specificity of 96.4%and 90.8%.4 joints Pearson correlation analysis showed that serum levels of miR-182-5p in AKI group were positively correlated with Scr,Cys-C and KIM-1(r=0.683,r=0.795,r=0.847,P<0.01).Conclusion:Serum levels of miR-182-5p is significantly increased in secondary AKI of sepsis children,which is an independent risk factor for secondary AKI of sepsis children,and the combination of Scr,Cys-C and KIM-1 levels has high value in predicting AKI.