脓毒症患儿血浆miR-455-5p和miR-483-5p检测的临床应用

Clinical Application of Plasma miR-455-5p and miR-483-5p in Children with Sepsis

目的分析脓毒症(Sepsis)患儿血浆微小核糖核酸(micro RNA,miR)-455-5p和miR-483-5p检测及其临床价值。方法选择2019年1月~2020年12月三亚市人民医院收治的108例脓毒症患儿,根据其病情严重程度分为脓毒症非休克组(n=65)和脓毒症休克组(n=43);根据脓毒症患儿28天的生存情况,将其分为存活组(n=74)和死亡组(n=34),另选取50例健康儿童作为对照组,检测各组血浆miR-455-5p和miR-483-5p表达水平。应用受试者工作特征曲线(ROC)分析血浆miR-455-5p,miR-483-5p及降钙素原(procalcitonin,PCT)水平对脓毒症诊断及预后评估的价值。结果脓毒症休克组血浆miR-455-5p(4.06±1.35),miR-483-5p(3.40±1.13)及PCT(19.97±9.12μg/L)水平均明显高于脓毒症非休克组(1.95±0.81,1.38±0.57,5.73±2.36μg/L)和对照组(0.78±0.24,0.35±0.10,0.02±0.01μg/L),差异均有统计学意义(t=12.985~24.638,均P<0.01)。死亡组血浆miR-455-5p(4.30±1.52),miR-483-5p(3.61±1.24)及PCT(21.35±9.58)水平均明显高于存活组(1.74±0.68,1.20±0.45,4.36±1.94μg/L)和对照组,差异均有统计学意义(t=10.513~21.719,均P<0.01)。ROC曲线分析显示,miR-455-5p,miR-483-5p及PCT联合诊断脓毒症的曲线下面积(AUC)最大(0.904,95%CI:0.846~0.967),其敏感度和特异度分别为92.4%和83.7%。miR-455-5p,miR-483-5p及PCT联合预测脓毒症患儿死亡的AUC最大(0.928,95%CI:0.870~0.984),其敏感度和特异度分别为94.7%和86.5%。结论脓毒症患儿血浆miR-455-5p和miR-483-5p表达水平明显升高,联合PCT检测有助于提高儿童脓毒症的诊断及预后评估价值。

Objective To analyze the detection and clinical value of plasma miR-455-5p and miR-483-5p in children with Sepsis.Methods 108 cases children with sepsis admitted to Sanya People’s Hospital from January 2019 to December 2020 were divided into sepsis non shock group(n=65)and sepsis shock group(n=43).According to the 28 day survival of children with sepsis,they were divided into two groups:survival group(n=74)and death group(n=34).Another 50 healthy children were selected as the control group.The expression levels of plasma miR-455-5p and miR-483-5p were detected in each group.Receiver operating characteristic curve(ROC)was used to analyze the value of plasma levels of miR-455-5p,miR-483-5p and procalcitonin(PCT)for the diagnosis and prognosis of sepsis.Results The levels of plasma miR-455-5p(4.06±1.35),miR-483-5p(3.40±1.13)and PCT(19.97±9.12μg/L)in septic shock group were significantly higher than those in septic non shock group(1.95±0.81,1.38±0.57,5.73±2.36μg/L)and control group(0.78±0.24,0.35±0.10,0.02±0.01μg/L),the differences were statistically significant(t=12.985~24.638,all P<0.01).The levels of plasma miR-455-5p(4.30±1.52),miR-483-5p(3.61±1.24)and PCT(21.35±9.58μg/L)in the death group were significantly higher than those in the survival group(1.74±0.68,1.20±0.45,4.36±1.94μg/L)and control group,the differences were statistically significant(t=10.513~21.719,all P<0.01).ROC curve analysis showed that the area under the curve(AUC)of miR-455-5p,miR-483-5p and PCT in the diagnosis of sepsis was the largest(0.904,95%CI:0.846~0.967),with a sensitivity of 92.4%and a specificity of 83.7%.The AUC of miR-455-5p,miR-483-5p and PCT in predicting the death of children with sepsis was the largest(0.928,95%CI:0.870~0.984),with a sensitivity of 94.7%and a specificity of 86.5%.Conclusion The expression levels of plasma miR-455-5p and miR-483-5p in children with sepsis were significantly increased.Combined with PCT detection,it is helpful to improve the value of diagnosis and prognosis evaluation of children with sepsis.