外周血miRNA-146a、miRNA-155和miRNA-186在重症肺炎患者中的表达及临床意义

Expression and clinical significance of peripheral blood miRNA-146a,miRNA-155 and miRNA-186 in patients with severe pneumonia

目的探讨外周血miRNA-146a、miRNA-155和miRNA-186在重症肺炎患者中的表达及临床意义。方法选择宁波市医疗中心李惠利医院东部院区2019年2月至2021年2月收治的重症肺炎患者79例为研究对象,按照入院28 d预后情况,分为存活组(58例)与死亡组(21例);另选择同时段健康体检者60例为对照组。采集研究对象外周血标本,分离血清,采用实时荧光定量PCR法(qRT-PCR)测定外周血miRNA-146a、miRNA-155和miRNA-186表达。结果重症肺炎组急性生理学和慢性健康状态Ⅱ(APACHE Ⅱ)评分[(18.54±2.83)分]高于对照组[(3.18±0.57)分](t=41.37,P < 0.05)。重症肺炎组外周血miRNA-146a相对表达量(0.32±0.07)低于对照组(1.08±0.21),而miRNA-155相对表达量(2.54±0.46)和miRNA-186相对表达量(3.16±0.38)均高于对照组[(0.42±0.09)、(0.89±0.17)](t=30.07、35.16、43.08,均P < 0.001)。死亡组外周血miRNA-146a相对表达量(0.25±0.68)低于存活组(0.59±0.12),而miRNA-155相对表达量(3.97±0.78)和miRNA-186相对表达量(5.23±0.86)均高于存活组[(0.89±0.21)、(1.52±0.23)](t=19.11、27.69、30.29,均P < 0.001)。APACHE Ⅱ评分与miRNA-146a呈线性负相关(r=-0.75,P=0.015),而与miRNA-155和miRNA-186呈线性正相关(r=0.82、0.70,P=0.002、0.021)。重症肺炎诊断中,miRNA-146a灵敏度为72.34%,特异度为62.50%;miRNA-155灵敏度为75.00%,特异度为62.96%;miRNA-186灵敏度为66.67%,特异度为48.65%。结论外周血miRNA-146a在重症肺炎中低表达,而miRNA-155和miRNA-186在重症肺炎中高表达,且miRNA-146a、miRNA-155和miRNA-186与患者预后密切相关。

Objective To investigate the expression and clinical significance of peripheral blood miRNA-146a,miRNA-155 and miRNA-186 in patients with severe pneumonia.Methods Seventy-nine patients with severe pneumonia who received treatment in Eastern Branch of Ningbo Medical Center Li Huili Hospital from February 2019 to February 2021 were included in this study.They were divided into survival and death groups according to prognosis at 28 days after admission.An additional 60 subjects who concurrently received health examination in the same hospital were included in the control group.Peripheral blood samples were collected and serum was separated.The expression of miRNA-146a,miRNA-155 and miRNA-186 in peripheral blood was determined by real-time fluorescent quantitative PCR.Results Acute Physiology and Chronic Health Evaluation II(APACHE II)score in the severe pneumonia group was significantly higher than that in the control group[(18.54±2.83)points vs.(3.18±0.57)points,t=41.37,P<0.05].The relative expression of miRNA-146a in peripheral blood in the severe pneumonia group was significantly lower than that in the control group[(0.32±0.07)vs.(1.08±0.21)],while the relative expression of miRNA-155 and miRNA-186 in the severe pneumonia group were(2.54±0.46)and(3.16±0.38),which were significantly higher than(0.42±0.09)and(0.89±0.17)in the control group(t=30.07,35.16,43.08,all P<0.05).The relative expression of miRNA-146a in peripheral blood in the death group was significantly lower than that in the survival group[(0.25±0.68)vs.(0.59±0.12),t=19.11,P<0.001].The relative expression of miRNA-155 and miRNA-186 in the death group were(3.97±0.78)and(5.23±0.86),which were significantly higher than(0.89±0.21)and(1.52±0.23)in the survival group(t=27.69,30.29,both P<0.05).APACHE II score was linearly negatively correlated with miRNA-146a(r=-0.75,P=0.015),and it was linearly positively correlated with miRNA-155 and miRNA-186(r=0.82,0.70,P=0.002,0.021).In the diagnosis of severe pneumonia,miRNA-146a has a sensitivity of 72.34%and a specificity of 62.50%;miRNA-155 has a sensitivity of 75.00%and a specificity of 62.96%;miRNA-186 has a sensitivity of 66.67%and a specificity of 48.65%.Conclusion Peripheral blood miRNA-146a is lowly expressed in severe pneumonia,while miRNA-155 and miRNA-186 are highly expressed in severe pneumonia,and miRNA-146a,miRNA-155 and miRNA-186 are closely related to the prognosis of severe pneumonia.