血清mir-124预测肺炎继发脓毒症的价值研究

Study on value of serum miR-124 in predicting sepsis secondary to pneumonia

目的探讨血清mir-124水平在肺炎继发脓毒症中的诊断价值。方法选取2016年8月至2019年6月该院重症医学科收治的肺炎患者126例,其中单纯肺炎71例,肺炎继发脓毒症42例,肺炎继发脓毒性休克13例,通过实时荧光定量聚合酶链式反应(qRT-PCR)检测所有受试者血清miR-124水平,通过酶联免疫吸附试验(ELISA)检测所有受试者血清降钙素原(PCT)水平,比较各组受试者血清miR-124、PCT水平、急性生理与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭估计评分(SOFA评分),采用二元logistic回归分析影响肺炎继发脓毒症的危险因素,绘制受试者工作特征曲线(ROC)分析并比较血清miR-124、PCT水平对肺炎患者继发脓毒血症的诊断价值。结果与单纯肺炎组比较,继发性脓毒症组、脓毒性休克组患者血清miR-124水平显著降低(P<0.05),血清PCT水平及APACHEⅡ评分显著升高(P<0.05);与继发性脓毒症组比较,脓毒性休克组患者血清miR-124水平显著降低(P<0.05),血清PCT水平及APACHEⅡ评分、SOFA评分显著升高(P<0.05)。Pearson相关性分析显示,继发脓毒症组及脓毒性休克组中患者血清miR-124水平与APACHEⅡ评分、SOFA评分呈负相关(P<0.05);血清PCT水平与APACHEⅡ评分、SOFA评分呈正相关(P<0.05)。二元logistic回归分析显示,血清miR-124水平低,血清PCT水平、APACHEⅡ评分、SOFA评分高为肺炎患者继发脓毒症的危险因素(P<0.05)。血清miR-124水平诊断肺炎继发脓毒症的曲线下面积为0.860(灵敏度为85.7%,特异度为83.3%),血清PCT水平诊断肺炎继发脓毒症的曲线下面积为0.935(灵敏度为93.0%,特异度为90.8%),二者诊断肺炎继发脓毒症的曲线下面积比较,差异无统计学意义(P>0.05)。结论肺炎继发脓毒症患者血清miR-124水平降低,对肺炎患者继发脓毒血症具有一定诊断价值。

Objective To investigate the diagnostic value of serum miR-124 level in pneumonia secondary sepsis.Methods A total of 126 cases of pneumonia treated in the critical care medicine department of this hospital from August 2016 to June 2019 were selected,including 71 cases of simple pneumonia,42 cases of pneumonia secondary sepsis and 13 cases of pneumonia secondary septic shock.The serum miR-124 level in all subjects was detected by using the real time fluorescence quantitative polymerase chain reaction(qRT-PCR),the serum procalcitonin level(PCT)was measured by enzyme linked immunosorbent assay(ELISA),the levels of serum miR-124,PCT,acute physiology and chronic health(APACHEⅡ)score,sequential organ failure assessment(SOFA)score were compared among the groups,the binary logistic regression was used to analyze the risk factors affecting pneumonia secondary sepsis,and the diagnostic values of serum miR-124 and PCT levels in the patients with pneumonia secondary sepsis were analyzed and compared by drawing the receiver operating characteristic(ROC).Results Compared with the simple pneumonia group,the serum miR-124 level in the secondary sepsis group and septic shock group was significantly decreased(P<0.05),the serum PCT level and APACHEⅡscore were significantly increased(P<0.05);compared with the secondary sepsis group,the serum miR-124 level in the septic shock group was significantly decreased(P<0.05),the serum PCT level,APACHEⅡscore and SOFA score were significantly increased(P<0.05).The Pearson correlation analysis showed that the serum miR-124 level in the secondary sepsis group and septic shock group was negatively correlated with the APACHEⅡscore and SOFA score(P<0.05);and the serum PCT level was positively correlated with the APACHEⅡscore and SOFA score(P<0.05).The binary logistic regression analysis showed that the low serum miR-124 level,serum PCT,APACHEⅡscore and high SOFA score were the risk factors of secondary sepsis in the patients with pneumonia(P<0.05).The area under the curve of level of serum miR-124 in the diagnosis of pneumonia secondary sepsis was 0.860(sensitivity was 85.7%,specificity was 83.3%),the area under the ROC curve of PCT level for diagnosing pneumonia secondary sepsis was 0.935(sensitivity was 93.0%,specificity was 90.8%),and the areas under the curves for diagnosing pneumonia secondary sepsis had no statistically significant difference between them(P>0.05).Conclusion The serum miR-124 level in the patients with pneumonia secondary sepsis is decreased,which has a certain diagnostic value for pneumonia secondary sepsis.