急性腹膜炎伴脓毒症患者28 d预后影响因素及miR-150、miR-146a对病情的评估价值

Influencing factors of 28 d prognosis of patients with acute peritonitis and sepsis and the evaluation value of miR-150 and miR-146a on the condition of disease

目的探讨急性腹膜炎伴脓毒症患者28 d预后的影响因素及微小RNA-150(miR-150)、miR-146a对病情的评估价值。方法收集2016年10月-2020年7月温岭市第一人民医院的急性腹膜炎伴脓毒症患者260例的临床病例资料进行回顾性分析,比较患者于入院时(M0)、入院后12 h(M1)、入院后24 h(M2)、入院后48 h(M3)时外周血miR-150、miR-146a水平变化。根据患者28 d临床预后的不同将其分为存活组(n=192)与死亡组(n=68),比较两组一般资料情况,归纳急性腹膜炎伴脓毒症患者28 d临床预后的影响因素,采用受试者工作特征(ROC)曲线分析M3时外周血miR-150、miR-146a水平对急性腹膜炎伴脓毒症患者28 d死亡结局的预测价值。分析急性腹膜炎伴脓毒症患者外周血miR-150、miR-146a水平与其病情严重程度的的相关性。结果急性腹膜炎伴脓毒症患者于M0、M1、M2、M3时外周血miR-150、miR-146a水平逐渐降低(P<0.05)。外周血miR-150、miR-146a是急性腹膜炎伴脓毒症28 d死亡结局的影响因素(P<0.05)。M3时miR-150、miR-146a及miR-150联合miR-146a对急性腹膜炎伴脓毒症患者28 d临床预后均具有预测价值(P<0.05),且miR-150联合miR-146a的曲线下面积(AUC)大于miR-150、miR-146a(P<0.05)。急性腹膜炎伴脓毒症患者外周血miR-150、miR-146a水平越低,其病情严重程度越重(r=0.325、0.411,P<0.05)。结论急性腹膜炎伴脓毒症患者外周血miR-150、miR-146a时序变化与其病情严重程度、28 d死亡结局均密切相关,有望成为临床评估该病患者病情与临床预后的新指标。

OBJECTIVE To explore the factors influencing the prognosis of patients with acute peritonitis and sepsis at 28 days and the evaluation value of miR-150 and miR-146 a on the condition of the disease.METHODS The clinical data of 260 patients with acute peritonitis and sepsis in Wenling First People′s Hospital from Oct.2016 to Jul.2020 were collected for retrospective analysis.The changes of peripheral blood miR-150 and miR-146 a levels at admission(M0),12 h after admission(M1),24 h after admission(M2) and 48 h after admission(M3) were compared.According to the 28 d clinical prognosis of patients,they were divided into survival group(n=192) and death group(n=68).The general data of the two groups were compared,and the influencing factors of 28 d clinical prognosis of patients with acute peritonitis and sepsis were summarized,and the receiver operating characteristic(ROC) curve was used to analyze the predictive value of peripheral blood miR-150 and miR-146 a levels at M3 for 28 d death outcomes of patients with acute peritonitis and sepsis.The correlation between the levels of miR-150 and miR-146 a in peripheral blood of patients with acute peritonitis and sepsis and the severity of the disease.RESULTS The levels of peripheral blood miR-150 and miR-146 a in patients with acute peritonitis and sepsis were gradually decreased at M0,M1,M2 and M3(P<0.05).The peripheral blood miR-150 lowering than 10.61 and miR-146 a lowering than 13.38 were the influencing factors of 28 d death outcomes of acute peritonitis with sepsis(OR=2.280,2.307,P<0.05).The miR-150,miR-146 a,and miR-150 combined with miR-146 a at M3 were of predictive value for the 28 d clinical prognosis of patients with acute peritonitis with sepsis(P<0.05),and area under the curve(AUC) of miR-150 combined with miR-146 a was significantly greater than that of miR-150 and miR-146 a(P<0.05).The lower the levels of miR-150 and miR-146 a in peripheral blood of patients with acute peritonitis and sepsis,the more severe the disease(r=0.325,0.411,P<0.05).CONCLUSION The temporal changes of miR-150 and miR-146 a in peripheral blood of patients with acute peritonitis and sepsis were closely related to the severity of disease and 28 d death outcomes,which would be expected to be new indexes for clinically evaluating patient′s conditions and clinical prognosis.