miR-146b对脓毒症并发ARDS的预测及与预后的关系分析

MiR-146b in predicting sepsis complicating ARDS and its relationship with prognosis

目的 探讨微小分子核糖核酸-146b(miR-146b)对脓毒症并发急性呼吸窘迫综合征(ARDS)的预测价值及与预后的关系。方法 选取该院2016年9月至2020年9月收治的脓毒症患者272例作为脓毒症组,同期于该院体检的健康志愿者92例作为对照组,根据脓毒症组是否发生ARDS分成ARDS组、非ARDS组。比较各组血清miR-146b水平,利用Logistic多元回归模型分析脓毒症患者ARDS发生的危险因素,绘制受试者工作特征(ROC)曲线分析miR-146b评估脓毒症并发ARDS的曲线下面积(AUC)。根据ARDS组的血清miR-146b水平分成高水平组、低水平组,绘制Kaplan-Meier生存曲线图,分析miR-146b水平与患者预后的关系。结果 脓毒症组血清miR-146b水平低于对照组(P<0.05),且ARDS组血清miR-146b水平低于非ARDS组(P<0.05)。Logistic多元回归分析提示肺部感染、胰腺炎合并胰周感染、序贯器官功能衰竭(SOFA)评分≥6分、感染性休克是脓毒症患者发生ARDS的危险因素(P<0.05),而氧合指数为200~300 mm Hg、血清miR-146b水平≥0.90是脓毒症患者发生ARDS的保护因素(P<0.05)。miR-146b评估脓毒症并发ARDS风险的AUC为0.793。2周内,miR-146b高水平组的生存率高于miR-146b低水平组,差异有统计学意义(Log-rankχ^(2)=12.051,P=0.001)。结论 脓毒症并发ARDS患者的血清miR-146b水平下降,其对ARDS的发生风险有一定评估价值,且有望成为预测该病预后的指标。

Objective To explore the predictive value of microRNA-146b(miR-146b)in sepsis complicating acute respiratory distress syndrome(ARDS)and its relationship with prognosis.Methods A total of 272 patients with sepsis admitted to this hospital from September 2016 to September 2020 were selected as the sepsis group,and 92 healthy volunteers undergoing physical examination in this hospital during the same period served as the control group.The sepsis group,they were divided into the ARDS group and non-ARDS group according to whether ARDS occurred.The serum miR-146b level were compared among the various groups,and the Logistic multiple regression model was used to analyze the risk factors of ARDS occurrence in the patients with sepsis.The receiver operating characteristic(ROC)curve was drawn to analyze the area under the curve(AUC)of miR-146b for evaluating sepsis complicating ARDS.The ARDS group was divided into the high level group and low level group according to the serum miR-146b level.The Kaplan-Meier survival curve was drawn to analyze the relationship between serum miR-146b level with the patient′s prognosis.Results The serum miR-146b level in the sepsis group was lower than that in the control group(P<0.05),moreover serum miR-146b level in ARDS group was lower than that in the non-ARDS group(P<0.05).The Logistic multiple regression analysis showed that the pulmonary infection,pancreatitis complicating peripancreatic infection,SOFA score≥6 points and septic shock were the risk factors of ARDS occurrence in the patients with sepsis(P<0.05).The oxygenation index of 200-300 mm Hg and the expression level of serum miR-146b level≥0.90 were protective factors of ARDS occurrence in the patients with sepsis(P<0.05).AUC of miR-146b for assessing the occurrence risk of sepsis complicating ARDS was 0.793.The survival rate of the miR-146b high level group was higher than that of the miR-146b low level group(Log-rank χ^(2)=12.051,P=0.001).Conclusion The serum miR-146b level in the patients with sepsis complicating ARDS is decreased,which has a certain evaluation value for the occurrence risk of ARDS,moreover is expected to be an indicator for predicting the prognosis of the disease.