脓毒症患儿外周血miR-146a、miR-223的表达及与预后的关系

Expression of miR-146a and miR-223 in peripheral blood of children with sepsis and their relationship with prognosis

目的 探讨脓毒症患儿外周血miR-146a、miR-223的表达及与预后的关系。方法 选取2019年1月至2021年1月该院收治的93例脓毒症患儿为脓毒症组,同期选取该院93例体检健康儿童为对照组,比较两组一般资料、外周血miR-146a、miR-223水平及血清C-反应蛋白(CRP)、降钙素原(PCT)水平。根据急性生理与慢性健康(APACHEⅡ)评分将脓毒症患儿分为轻度组42例,中度组29例和重度组22例,比较3组各指标水平,并采用Pearson相关分析脓毒症患儿miR-146a、miR-223水平与CRP、PCT水平及APACHEⅡ评分、序贯器官衰竭(SOFA)评分的相关性。根据28 d内存活情况将脓毒症患儿分为存活组69例和死亡组24例,比较两组miR-146a、miR-223、CRP及PCT水平,并采用受试者工作特征(ROC)曲线分析miR-146a、miR-223、CRP及PCT水平在评估脓毒症患儿预后中的临床价值。结果 与对照组比较,脓毒症组miR-146a、miR-223、CRP、PCT水平升高(P<0.05)。脓毒症病情程度越严重,患儿miR-146a、miR-223、CRP、PCT水平越高(P<0.05)。相关性分析结果显示,miR-146a、miR-223水平与CRP、PCT水平及APACHEⅡ、SOFA评分均呈正相关(P<0.05)。与存活组比较,死亡组miR-146a、miR-223、CRP、PCT水平更高(P<0.05)。ROC曲线结果显示,miR-146a、miR-223在评估患儿预后中的曲线下面积(AUC)均>0.8,而CRP、PCT在评估患儿预后中的AUC均<0.8。结论 脓毒症患儿miR-146a、miR-223、PCT及CRP水平升高,并与患儿病情严重程度及炎症反应密切相关,miR-146a、miR-223水平在评估患儿预后中均具有一定临床价值,但PCT及CRP水平在评估患儿预后中的临床价值并不显著。

Objective To investigate the expression of miR-146a and miR-223 in peripheral blood of children with sepsis and their relationship with prognosis.Methods From January 2019 to January 2021,93 children with sepsis treated in the hospital were selected as the sepsis group,and 93 healthy children with physical examination in the hospital were selected as the control group during the same period.The general data,the levels of miR-146a and miR-223 in peripheral blood,and the levels of serum C-reactive protein(CRP)and procalcitonin(PCT)were compared between the two groups.According to the acute physiology and chronic health(APACHEⅡ)score,children with sepsis were divided into mild group(42 cases),moderate group(29 cases)and severe group(22 cases),and the index levels of the three groups were compared.Pearson correlation was used to analyze the correlation of miR-146a and miR-223 levels with CRP and PCT levels,APACHEⅡscore and sequential organ failure(SOFA)score in children with sepsis.According to the survival status within 28 d,the children with sepsis were divided into the survival group(69 cases)and the death group(24 cases).The levels of miR-146a,miR-223,CRP and PCT were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the clinical value of miR-146a,miR-223,CRP and PCT levels in evaluating the prognosis of children.Results Compared with the control group,the levels of miR-146a,miR-223,CRP and PCT in the sepsis group were increased(P<0.05).The more severe the degree of sepsis,the higher the levels of miR-146a,miR-223,CRP and PCT in children(P<0.05).The results of correlation analysis showed that the levels of miR-146a and miR-223 were positively correlated with the CRP,PCT levels,APACHEⅡscore and SOFA score(P<0.05).Compared with the survival group,the levels of miR-146a,miR-223,CRP and PCT in the death group were higher(P<0.05).The ROC curve results showed that the area under the curve(AUC)of miR-146a and miR-223 in evaluating the prognosis of children were both>0.8,while the AUC of CRP and PCT in evaluating the prognosis of children were both<0.8.Conclusion The levels of miR-146a,miR-223,PCT and CRP in children with sepsis are increased,and are closely related to the severity of the disease and inflammatory response in children.The levels of miR-146a and miR-223 have certain clinical value in evaluating the prognosis of children,but the levels of PCT and CRP have no significant clinical value in evaluating the prognosis of children.