miR-10a、miR-21联合预测老年重症脓毒症患者的病死率

Combination of miR-10a and miR-21 to predict mortality of elderly patients with severe sepsis

目的:探究miR-10a、miR-21联合预测老年重症脓毒症患者28 d病死率的价值。方法:回顾102例老年重症脓毒症患者的资料,根据预后情况分为死亡组和存活组。比较2组入院时外周血miR-10a、miR-21,分析死亡的影响因素、APACHEⅡ评分与外周血miR-10a、miR-21的相关性及miR-10a、miR-21联合预测患者病死的效能。结果:28 d病死率为28.43%;死亡组外周血miR-10a、miR-21表达水平显著高于存活组(P<0.05);APACHEⅡ评分≥20分、CRP≥40 mg/ml、血清乳酸≥3 mmol/L、外周血miR-10a表达水平≥1.31、外周血miR-21表达水平≥2.39是老年重症脓毒症患者28 d病死的独立危险因素,Vit D>26 ng/ml是其保护因素;APACHⅡ评分与外周血miR-10a、miR-21无相关性(P>0.05);外周血miR-10a联合miR-21预测老年重症脓毒症患者28 d病死率的特异度、AUC均高于单独预测。结论:老年重症脓毒症患者28 d内病死率高,需根据影响因素加强防控,外周血miR-10a联合miR-21有理想的预测效能。

Objective:To investigate the combination of miR-10 a and miR-21 to predict the in 28 d mortality of elderly patients with severe sepsis.Methods:The data of 102 elderly patients with severe sepsis were retrospectively analyzed,who were divided into death group and survival group according to the prognosis.The expression levels of miR-10 a and miR-21 in peripheral blood at admission were compared between the two groups.Analysis the APACHEⅡscores and peripheral blood miR-10 a,the correlation of miR-21 and miR-10 a,miR-21 patients with combined forecasting the efficiency of the die.Results:The 28 d case-fatality rate was28.43%.At admission,the expression levels of miR-10 a and miR-21 in the death group were higher than those of the survival group(P<0.05).APACHEⅡscoring 20 points or more,CRP acuity 40 mg/ml,serum lactic acid or 3 mmol/L,peripheral blood miR-10 a expression level 1.31 or higher,peripheral blood miR-21 expression level 2.39 or higher is the tendency for the old patients with severe sepsis independent risk factors of 28 d died,VitD>26 ng/ml,blood glucose control was a protective factor.ApacheⅡscore had no correlation with peripheral blood mir-10 a and miR-21(P>0.05).The specificity and AUC of peripheral blood mir-10 a combined with miR-21 in predicting 28 d mortality of elderly patients with severe sepsis were higher than those predicted separately.Conclusion:The mortality of the elderly patients with severe sepsis is high with in 28 d,so it is necessary to strengthen the prevention and control according to the influencing factors.