急性肺损伤患者血浆miR-127及miR-155表达水平及对预后的影响

Expression of miR-127 and miR-155 in patients with acute lung injury and its effect on prognosis

目的:探讨急性肺损伤(ALI)患者血浆miR-127及miR-155表达水平及其临床意义。方法:选取2016-01—2019-06期间我院收治的ALI患者145例,根据ALI患者生存情况分为存活组(n=91)和死亡组(n=54)。采用急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分标准将ALI患者分为低中危组(n=79)和高危组(n=66)。采用实时荧光定量PCR检测各组血浆miR-127及miR-155表达水平。应用多因素Logistic回归分析ALI患者死亡的危险因素。绘制ROC曲线分析血浆miR-127及miR-155表达水平及APACHEⅡ评分预测ALI患者死亡的价值。结果:死亡组血浆miR-127(3.22±1.04 vs.1.05±0.46)及miR-155(2.46±0.75 vs.0.84±0.32)表达水平均明显高于存活组(P<0.01)。高危组血浆miR-127(3.04±0.95 vs.1.31±0.52)、miR-155(2.38±0.71 vs. 0.97±0.38)表达水平及死亡率(60.6%vs. 17.7%)均明显高于低中危组(P<0.01)。多因素Logistic回归分析显示,APACHEⅡ评分(OR=2.582,95%CI:1.674~4.105)、血浆miR-127(OR=3.306,95%CI:2.428~6.174)及miR-155(OR=2.804,95%CI:1.903~5.226)表达水平升高是ALI患者死亡的独立危险因素(P<0.01)。ROC曲线分析显示,血浆miR-127、miR-155表达水平及APACHEⅡ评分预测ALI患者死亡的最佳截断值分别为2.25、1.64、18.50分,3项联合预测ALI患者死亡的曲线下面积(0.922,95%CI:0.864~0.983)最大,其敏感度(93.7%)和特异度(87.4%)较好。结论:血浆miR-127及miR-155表达水平升高与ALI患者预后不良相关,是ALI患者死亡的独立危险因素,联合APACHEⅡ评分对预测ALI患者死亡具有一定的价值。

Objective: To investigate the expression level of plasma miR-127 and miR-155 in patients with acute lung injury(ALI) and its clinical significance. Method: One hundred and fourty-five patients with ALI admitted to our hospital from January 2016 to June 2019 were selected and divided into survival group(n=91) and death group(n=54) according to the survival condition of ALI patients. ALI patients were divided into low middle risk group(n=79) and high risk group(n=66) according to the APACHE Ⅱ score. Real-time fluorescent quantitative PCR was used to detect the expression of miR-127 and miR-155 in plasma of each group. Multivariate logistic regression was used to analyze the risk factors of death in ALI patients. Draw the ROC curve analysis of plasma miR-127 and miR-155 expression levels and APACHE Ⅱ score predicts the value of death in patients with ALI. Result: The expression levels of plasma miR-127(3.22±1.04 vs. 1.05±0.46) and miR-155(2.46±0.75 vs. 0.84±0.32) in the death group were significantly higher than those in the survival group(P<0.01). The levels of plasma miR-127(3.04±0.95 vs. 1.31±0.52), miR-155(2.38±0.71 vs. 0.97±0.38) and mortality(60.6% vs. 17.7%) in the high risk group were significantly higher than those in the low middle risk group(P<0.01). Multivariate logistic regression analysis showed that APACHE Ⅱ score(OR=2.582, 95%CI: 1.674-4.105), the increased expression of plasma miR-127(OR=3.306, 95%CI: 2.428-6.174) and miR-155(OR=2.804, 95%CI: 1.903-5.226) were independent risk factors for ALI death(P<0.01). ROC curve analysis showed that the plasma miR-127, miR-155 expression levels and APACHE Ⅱ score predicts the optimal cutoff value of death in patients with ALI were 2.25, 1.64, 18.50, respectively. Three joint predict the area under the curve of death in patients with ALI were the largest, its sensitivity(93.7%) and specific degrees(87.4%) were better. Conclusion: Plasma miR-127 and miR-155 expression levels associated with poor prognosis of patients with ALI, were the independent risk factors of death in patients with ALI, joint APACHE Ⅱ score for predicting death ALI has a certain value.