肝硬化上消化道出血患者血清miR-130a表达情况及与病情严重程度和预后的相关性

Expression of Serum miR-130a in Patients with Liver Cirrhosis and Upper Gastrointestinal Hemorrhage and Its Correlations with Disease Severity and Prognosis

目的分析肝硬化上消化道出血患者血清miR-130a表达情况及与病情严重程度和预后的相关性。方法选择2017年1月—2020年1月诊治的肝硬化208例,根据是否合并上消化道出血分为出血组90例与无出血组118例,并选择同期健康体检的志愿者57例为对照组,比较3组血清miR-130a相对表达量。受试者工作特征(ROC)曲线分析血清miR-130a表达对肝硬化患者上消化道出血的评估价值。Spearman相关分析肝硬化上消化道出血患者血清miR-130a表达与肝功能分级、出血严重程度的关系,Cox回归模型分析影响患者预后的独立危险因素。结果出血组病程、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、肝功能Child分级评分、终末期肝病模型评分、血清miR-130a表达水平高于无出血组,白蛋白(ALB)低于无出血组(P<0.05)。出血组和无出血组凝血酶原时间、APTT、凝血酶时间、FIB、国际标准化比值、血清miR-130a表达水平高于对照组,ALB、血小板低于对照组(P<0.05)。血清miR-130a表达水平评估肝硬化患者上消化道出血的曲线下面积为0.861(95%CI:0.806,0.905)。肝硬化上消化道出血患者血清miR-130a表达与肝功能分级及出血严重程度均呈正相关性(P<0.05)。病程、肝功能Child分级评分及血清miR-130a表达水平是影响肝硬化上消化道出血患者预后的独立危险因素(P<0.05)。结论肝硬化上消化道出血患者血清miR-130a表达水平显著升高,并与肝功能分级及出血严重程度呈正相关性,是影响患者预后的独立危险因素。

Objective To analyze the expression of serum miR-130a in patients with liver cirrhosis and upper gastrointestinal hemorrhage and its correlations with disease severity and prognosis.Methods A total of 208 patients with liver cirrhosis treated between January 2017 and January 2020 were selected,and they were divided into hemorrhage group(n=90)and non-hemorrhage group(n=118)according to presence of upper gastrointestinal hemorrhage,and other 57 healthy volunteers who had undergone physical examinations at the same period were selected as control group.The relative expressions of serum miR-130a were compared among three groups.Receiver operating characteristic(ROC)curve was used to analyze the value of serum miR-130a expression in evaluation of upper gastrointestinal hemorrhage in patients with liver cirrhosis.Spearman correlation analysis was used to analyze the relationships between serum miR-130a expression with liver function classification and severity of upper gastrointestinal hemorrhage in patients with liver cirrhosis and upper gastrointestinal hemorrhage.The independent risk factors affecting prognoses of patients were analyzed by COX regression model.Results Compared with those in non-hemorrhage group,course of disease,levels of activated partial thromboplastin time(APTT)and fibrinogen(FIB),Child classification score for liver function,model score for end stage liver disease and expression of serum miR-130a were significantly higher,while the level of albumin(ALB)was significantly lower in hemorrhage group(P<0.05).In hemorrhage and non-hemorrhage groups,prothrombin time,APTT,thrombin time,FIB,international standardized ratio and expression of serum miR-130a were significantly higher,while ALB and platelet levels were significantly lower than those in control group(P<0.05).The area under ROC curve of serum miR-130a expression in evaluation of upper gastrointestinal hemorrhage in patients with liver cirrhosis was 0.861(95%CI:0.806,0.905).Serum miR-130a expression was positively correlated with liver function classification and the severity of upper gastrointestinal hemorrhage in patients with liver cirrhosis and upper gastrointestinal hemorrhage(P<0.05).Course of disease,Child classification score for liver function and serum miR-130a expression were independent risk factors affecting the prognoses of patients with liver cirrhosis and upper gastrointestinal hemorrhage(P<0.05).Conclusion Expressions of serum miR-130a increase significantly in patients with liver cirrhosis and upper gastrointestinal hemorrhage,which is significantly positively correlated with liver function classification and severity of upper gastrointestinal hemorrhage.It is an independent risk factor affecting the prognoses of patients.