血清miR-21-3p、IL-10、TNF-α、BNP在脓毒症心肌病患者诊断及预后评估中的价值

Value of serum miR-21-3p,IL-10,TNF-α and BNP in the diagnosis and prognosis evaluation of patients with sepsis-induced cardiomyopathy

目的探究血清miR-21-3p、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、脑利钠肽(BNP)在脓毒症心肌病(SIC)患者诊断及预后评估中的价值。方法选取2017年8月至2019年12月在青海省人民医院就诊的SIC患者104例作为观察组,同期选取50名健康体检者作为对照组。比较两组血清miR-21-3p、IL-10、TNF-α、BNP水平,并采用ROC曲线探究各指标对SIC诊断价值。根据28 d内死亡情况将观察组分为存活组66例及死亡组38例,记录患者白细胞计数(WBC)水平、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ),探究影响SIC预后的危险因素。结果观察组血清miR-21-3p、IL-10、TNF-α、BNP水平均高于对照组,差异有统计学意义(P<0.05)。血清miR-21-3p与IL-10、TNF-α、BNP均呈正相关(r=0.747、0.527、0.765,P<0.05)。在诊断SIC时,BNP的曲线下面积(AUC)为0.932,高于miR-21-3p、IL-10、TNF-α的0.896、0.919、0.866,差异有统计学意义(P<0.05)。存活组的血清miR-21-3p、IL-10、TNF-α、BNP、SOFA、APACHEⅡ评分均低于死亡组,差异有统计学意义(P<0.05),两组的年龄、性别、WBC差异无统计学意义(P>0.05)。多因素分析显示,miR-21-3p、IL-10、TNF-α、BNP、SOFA是影响SIC患者预后的危险因素。结论血清miR-21-3p、IL-10、TNF-α、BNP与SIC发生、发展相关,可作为SIC早期诊断及预后的标志物。

Objective To explore the value of serum miR-21-3p,interleukin-10(IL-10),tumor necrosis factor-α(TNF-α) and brain natriuretic peptide(BNP) in the diagnosis and prognosis evaluation of patients with sepsis-induced cardiomyopathy(SIC).Methods A total of 104 SIC patients who were treated in the hospital from August 2017 to December 2019 were enrolled as observation group,while another 50 healthy controls during the same period were enrolled as control group.The levels of serum miR-21-3p,IL-10,TNF-α and BNP were compared between the two groups.The diagnostic value of each index for SIC was explored by ROC curves.According to death situations within 28 d,patients in observation group were divided into survival group(66 cases)and death group(38 cases).The level of white blood cell count(WBC),scores of sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)were recorded.The risk factors of SIC prognosis were explored.Results The levels of serum miR-21-3p,IL-10,TNF-α and BNP in observation group were higher than those in control group(P<0.05).Serum miR-21-3p was positively correlated with IL-10,TNF-α and BNP(r=0.747,0.527,0.765,P<0.05).Area under the curve(AUC)values of BNP for diagnosis of SIC were 0.932,higher than that of miR-21-3p,IL-10,TNF-α(0.896,0.919,0.866,respectively)(P<0.05).The serum miR-21-3p,IL-10,TNF-α and BNP,scores of SOFA and APACHE Ⅱ in survival group were lower than those in death group(P<0.05).There were no significant differences in age,gender and WBC between the two groups(P>0.05).Multivariate analysis showed that miR-21-3p,IL-10,TNF-α,BNP and SOFA were risk factors of prognosis in SIC patients.Conclusion Serum miR-21-3p,IL-10,TNF-α and BNP are related to the occurrence and development of SIC,which can be applied as markers for early diagnosis and prognosis of SIC.