脓毒症并发急性肾损伤患儿血清miR-452-3p的水平表达及其临床意义

Expression and Clinical Significance of Serum miR-452-3p in Children with Sepsis Complicated with Acute Kidney Injury

目的探讨miR-452-3p在脓毒症并发急性肾损伤(acute kidney injury,AKI)患儿中的表达及其临床意义。方法选取2018年1月~2020年12月海口市妇幼保健院收治的脓毒症并发AKI患儿106例,根据生存情况分为生存组(n=71)和死亡组(n=35),检测两组血清miR-452-3p,中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及肾损伤分子-1(KIM-1)水平。应用多因素Logistic回归分析AKI患儿发生死亡的危险因素。绘制ROC曲线分析miR-452-3p,NGAL及KIM-1预测AKI患儿死亡的价值。结果死亡组血清miR-452-3p(3.92±1.61 vs 2.17±0.95),NGAL(562.38±53.62mg/L vs 287.46±31.70 mg/L)及KIM-1(29.15±6.28μg/L vs 15.96±3.20μg/L)水平明显高于生存组,差异均有统计学意义(t=18.245,15.117,11.613,均P<0.001)。多因素Logistic回归分析显示,miR-452-3p(OR=2.583,95%CI:1.690~5.374),NGAL(OR=2.792,95%CI:1.835~6.153)及KIM-1(OR=1.950,95%CI:1.274~3.902)水平升高是AKI患儿发生死亡的独立危险因素(P<0.001)。ROC曲线分析显示,miR-452-3p,NGAL及KIM-1三项联合预测AKI患儿死亡的曲线下面积(0.947,95%CI:0.886~0.991)最大,其敏感度和特异度分别为96.2%和89.5%。结论miR-452-3p在脓毒症并发AKI患儿中明显升高,联合NGAL及KIM-1预测AKI患儿死亡具有更高的价值。

Objective To investigate the expression and clinical significance of miR-452-3p in children with sepsis complicated with acute kidney injury(AKI).Methods The 106 children with sepsis complicated with AKI admitted to Haikou Hospital of the Maternal and Child Health from January 2018 to December 2020 were selected and divided into survival group(n=71)and death group(n=35)according to the survival situation.The levels of serum miR-452-3p,neutrophil gelatinase-related lipid carrier protein(NGAL)and kidney injury molecule-1(KIM-1)were detected in the two groups.Multivariate logistic regression was used to analyse the risk factors of death in children with AKI.The ROC curve was drawn to analyze the value of miR-452-3p,NGAL and KIM-1 in predicting the death of AKI children.Results The levels of serum miR-452-3p(3.92±1.61 vs 2.17±0.95),NGAL(562.38±53.62mg/L vs 287.46±31.70mg/L)and KIM-1(29.15±6.28μg/L vs 15.96±3.20μg/L)in the death group were significantly higher than those in the survival group,the differences were statistically significant(t=18.245,15.117,11.613,all P<0.001).Multivariate logistic regression analysis showed that increased levels of miR-452-3p(OR=2.583,95%CI:1.690~5.374),NGAL(OR=2.792,95%CI:1.835~6.153)and KIM-1(OR=1.950,95%CI:1.274~3.902)were independent risk factors for death in AKI children(P<0.001).ROC curve analysis showed that the area under the curve(0.947,95%CI:0.886~0.991)of miR-452-3p,NGAL and KIM-1 combined prediction of death in children with AKI was the largest,with a sensitivity of 96.2%and a specificit of 89.5%.Conclusion The level of serum miR-452-3p in children with sepsis complicated with AKI was significantly increased,and the combination of NGAL and KIM-1 has higher value in predicting the death of children with AKI.