外周血单个核细胞miRNA-492和miRNA-155水平表达与SNAPPE-Ⅱ评分对儿童急性呼吸窘迫综合征预后价值研究

Study on the Prognostic Value of miRNA-492 and miRNA-155 Levels in Peripheral Blood Mononuclear Cells and SNAPPE-ⅡScore in Children with Acute Respiratory Distress Syndrome

目的探究外周血单个核细胞miR-492和miR-155表达水平与新生儿急性生理学评分围产期补充Ⅱ评分(score for neonatal acute physiology perinatal extension,SNAPPE-Ⅱ)评价儿童急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)预后的价值。方法选取2019年9月~2020年11月兖矿新里程总医院及山东大学齐鲁儿童医院收治的ARDS患儿70例,分为死亡组(n=18)和存活组(n=52),同期健康体检儿童36例为对照组。比较三组miR-492,miR-155,氧合指数(PaO_(2)/FiO_(2)),SNAPPE-Ⅱ评分及急性生理与慢性健康(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分。分析3个指标与PaO_(2)/FiO_(2)和APACHEⅡ评分间的相关性及预测死亡的价值。结果三组儿童PaO_(2)/FiO_(2)(448.64±85.54,269.64±31.53,165.64±27.63 mmHg),APACHEⅡ评分(5.74±1.42,20.54±4.29,29.65±5.43分)、SNAPPE-Ⅱ评分(5.95±1.75,15.86±3.75,36.45±5.32分)、miR-492(3.75±0.98,5.63±1.41,9.54±2.25)和miR-155(1.75±0.95,3.84±0.53,5.64±1.74)水平比较,差异均有统计学意义(均P<0.05)。ARDS存活组与ARDS死亡组患儿PaO_(2)/FiO_(2),APACHEⅡ评分、SNAPPE-Ⅱ评分、miR-492,miR-155水平比较,差异均有统计学意义(t=9.245~16.546,均P<0.001)。PaO_(2)/FiO_(2)与miR-492,miR-155和SNAPPE-Ⅱ评分呈负相关(r=-0.584,-0.623,-0.594,均P<0.05);APACHEⅡ评分与miR-492,miR-155和SNAPPE-Ⅱ评分呈正相关(r=0.863,0.868,0.757,均P<0.05)。三指标联合预测死亡诊断效能高于单一指标,临界值miR-492为0.84,miR-155为1.43,SNAPPE-Ⅱ评分为22.8。结论miR-492,miR-155和SNAPPE-Ⅱ评分联合检测能够有效预测ARDS患儿预后,当miR-492>0.84,miR-155>1.43和SNAPPE-Ⅱ评分>22.8分时,ARDS患儿的死亡率较高。

Objective To explore the value of miR-492 and miR-155 expression levels and neonatal acute score for neonatal acute physiology perinatal supplementⅡscore(SNAPPE-Ⅱ)in evaluating the prognosis of children with acute respiratory distress syndrome(ARDS).Methods 70 children with ARDS admitted to Yankuang New Milestone General Hospital and Qilu Children’s Hospital of Shandong University from September 2019 to November 2020 were divided into death group(n=18)and survival group(n=52).During the same period,36 children under physical examination served as the control group.The three groups of miR-492,miR-155,PaO_(2)/FiO_(2),SNAPE-Ⅱscore and APACHEⅡscore were compared,and analyzed the correlation between the three indicators and PaO_(2)/FiO_(2),APACHEⅡscores and the value of predicting death.Results PaO_(2)/FiO_(2)(448.64±85.54,269.64±31.53,165.64±27.63 mmHg),APACHEⅡ(5.74±1.42,20.54±4.29,29.65±5.43),SNAP PE-Ⅱ(5.95±1.75,15.86±3.75,36.45±5.32),miR-492(3.75±0.98,5.63±1.41,9.54±2.25)and miR-155(1.75±0.95,3.84±0.53,5.64±1.74)in the three groups,the differences were statistically significant(all P<0.05).ARDS survival group and death group PaO_(2)/FiO_(2),APACHEⅡscores,SNAPPE-Ⅱscores,miR-492,miR-155 levels the differences were statistically significant(t=9.245~16.546,all P<0.001).PaO_(2)/FiO_(2) was negatively correlated with miR-492,miR-155 and SNAPPE-Ⅱscores(r=-0.584,-0.623,-0.594,all P<0.05).APACHEⅡscore was positively correlated with miR-492,miR-155 and SNAPPE-Ⅱscores(r=0.863,0.868,0.757,all P<0.05).The diagnostic performance of the three indicators combined to predict death was higher than that of a single indicator,the critical value of miR-492 was 0.84,miR-155 was 1.43,SNAPPE-Ⅱscore was 22.8.Conclusion The combination of miR-492,miR-155 and SNAPPE-Ⅱscores can effectively predict the prognosis of children with ARDS.When miR-492>0.84,miR-155>1.43 and SNAPPE-Ⅱscore>22.8,the mortality rate of children with ARDS higher.