不同药物麻醉下行肝肿瘤切除患者术后血浆miR-92a水平与肝损伤指标的关系

CORRELATION OF PLASMA MIR-92A LEVEL WITH LIVER INJURY INDICES IN PATIENTS UNDERGOING LIVER TUMOR RESECTION UNDER DIFFERENT ANESTHETICS

目的分析不同药物麻醉下行肝脏肿瘤切除患者术后血浆miR-92a水平与肝损伤指标的相关性,探讨血浆miR-92a表达水平对肝脏肿瘤切除术后肝损伤的诊断价值。方法将择期行肝脏肿瘤切除手术的93例患者按照麻醉药物不同分为七氟醚组48例和丙泊酚组45例。检测两组患者术后12 h血浆丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和总胆红素(TBIL)水平,采用RT-PCR方法检测两组患者血浆中miR-92a的相对表达量,并进行对比分析。采用Pearson相关分析分析两组患者血浆中ALT、AST与miR-92a水平的相关性,采用ROC曲线评价血浆中miR-92a对两组不同药物麻醉下肝肿瘤切除术患者肝损伤的诊断价值。结果七氟醚组患者血浆中ALT、AST、TBIL表达水平和miR-92a相对表达量均高于丙泊酚组(t=2.492~5.102,P<0.05)。Pearson相关分析显示,七氟醚组和丙泊酚组患者血浆中ALT、AST水平与miR-92a相对表达量均呈正相关(r=0.411~0.522,P<0.05)。ROC曲线分析结果显示,七氟醚组和丙泊酚组患者血浆中miR-92a诊断肝损伤的临界值分别为0.932、0.915时,对应的曲线下面积分别为0.972(95%CI=0.943~1.000,P<0.05)和0.868(95%CI=0.786~0.950,P<0.05),血浆中miR-92a对七氟醚组患者肝损伤诊断的灵敏度为87.2%,特异度为96.0%,对丙泊酚组患者肝损伤诊断的灵敏度为75.7%,特异度为96.0%。结论不同药物麻醉下行肝脏肿瘤切除患者术后血浆中miR-92a水平均与ALT、AST水平具有相关性,血浆中miR-92a水平对七氟醚和丙泊酚麻醉下行肝脏肿瘤切除术后患者肝损伤具有较高的预测价值,有望成为肝肿瘤切除术后肝损伤的诊断标志物。

Objective To investigate the correlation of plasma miR-92a level with liver injury indices in patients under-going liver tumor resection under different anesthetics,as well as the value of plasma miR-92a expression level in the diagnosis of liver injury after liver tumor resection.Methods According to the anesthetic used in surgery,a total of 93 patients who underwent elective liver tumor resection were divided into sevoflurane group with 48 patients and propofol group with 45 patients.The plasma levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),and total bilirubin(TBil)were measured at 12 h after surgery,and RT-PCR was used to measure the relative expression level of miR-92a in plasma for comparison.A Pearson correlation analysis was used to analyze the correlation of the plasma levels of ALT and AST with miR-92a level,and the receiver operating characteristic(ROC)curve was used to investigate the value of plasma miR-92a in the diagnosis of liver injury after liver tumor resection under different anesthetics.Results Compared with the propofol group,the sevoflurane group had significantly higher plasma expression levels of ALT,AST,and TBil and relative expression level of miR-92a(t=2.492-5.102,P<0.05).The Pearson correlation analysis showed that the plasma levels of ALT and AST were positively correlated with the relative expression level of miR-92a in both the sevoflurane group and the propofol group(r=0.411-0.522,P<0.05).The ROC curve analysis showed that in the sevoflurane group,miR-92a had an area under the ROC curve(AUC)of 0.972(95%CI=0.943-1.000,P<0.05)in the diagnosis of liver injury at the cut-off value of 0.932,and in the propofol group,miR-92a had an AUC of 0.868(95%CI=0.786-0.950,P<0.05)at the cut-off value of 0.915.For the patients in the sevoflurane group,plasma miR-92a had a sensitivity of 87.2%and a specificity of 96.0%in the diagnosis of liver injury,while for the patients in the propofol group,plasma miR-92a had a sensitivity of 75.7%and a specificity of 96.0%in the diagnosis of liver injury.Conclusion Plasma miR-92a level is correlated with ALT and AST levels in patients undergoing liver tumor resection under different anesthetics and has a relatively high value in predicting liver injury after liver tumor resection under sevoflurane or propofol,and therefore,it is expected to become a diagnostic marker for liver injury after liver tumor resection.