miR-424对脓毒症并急性呼吸窘迫综合征患儿早期诊断及预后评估的价值

Evaluation of the early diagnostic and prognostic value of miR-424 in children with sepsis complicated with acute respiratory distress syndrome

目的探讨miR-424对脓毒症并急性呼吸窘迫综合征(ARDS)风险的预测价值及其与ARDS预后的相关性。方法前瞻性研究。收集2020年2月至2021年2月河南省人民医院(郑州大学人民医院)收治的脓毒症患儿(含ARDS)资料, 记录患儿ARDS发生情况和ARDS患儿病死率, ARDS患儿根据是否死亡分为存活组和死亡组。采用定量反转录聚合酶链反应(RT-qPCR)检测患儿外周血单个核细胞miR-424的表达。采用Pearson相关分析探讨ARDS患儿miR-424表达与儿童危重症评分(PCIS)、序贯器官衰竭(SOFA)评分、氧合指数(P/F值)、C反应蛋白(CRP)、降钙素原(PCT)、炎症因子白细胞介素(IL)-6和IL-8等之间的关系。采用多因素Logistic回归分析影响ARDS患儿预后的因素。采用受试者工作特征曲线(ROC)评估miR-424对脓毒症并ARDS早期诊断的准确性, 评估miR-424对脓毒症并ARDS组患儿死亡的风险。结果共纳入脓毒症患儿121例, 其中并ARDS组36例。脓毒症并ARDS组患儿miR-424表达(0.56±0.17)明显低于脓毒症不并ARDS组(0.98±0.26)(t=8.776, P<0.001)。脓毒症并ARDS组患儿miR-424表达与IL-6(r=-0.627, P<0.01)、IL-8(r=-0.651, P<0.01)及CRP(r=-0.472, P<0.05)水平均呈负相关;与PCIS评分(r=0.330, P<0.05)、P/F值(r=0.592, P<0.001)、白蛋白(r=0.496, P<0.05)均呈正相关。ROC显示, miR-424[曲线下面积(AUC)=0.908, 95%CI:0.856~0.960]能够区分脓毒症并ARDS患儿和脓毒症不并ARDS患儿。与ARDS存活组相比, ARDS死亡组miR-424明显下降(0.42±0.14比0.63±0.15)(t=3.890, P<0.05);miR-424(AUC=0.845, 95%CI:0.696~0.995)降低预示ARDS患儿死亡风险增加。多因素Logistic回归分析显示, miR-424表达(OR=0.001, P=0.033 )、白蛋白(OR=0.553, P=0.040)为ARDS患儿死亡的独立危险因素。结论 miR-424对脓毒症并ARDS患儿的早期诊断和ARDS预后判定有预测价值。

Objective To measure the predictive value of miR-424 on the risk of sepsis complicated with acute respiratory distress syndrome(ARDS),and to explore its correlation with the prognosis of ARDS children.Methods A prospective study was conducted.The data of children with sepsis(some complicated with ARDS),who were treated in Henan Provincial People′s Hospital(People′s Hospital,Zhengzhou University)were collected from February 2020 to February 2021.The incidence of ARDS and the fatality rate of ARDS children were recorded.Children were divided into survival group and death group according to whether death or not.The expression of miR-424 in peripheral blood mononuclear cells was detected by quantitative reverse transcription polymerase chain reaction(RT-qPCR).Pearson correlation analysis was made to investigate the relationship between the expression level of miR-424 and Pediatric Critical Illness Score(PCIS),Sequential Organ Failure Assessment(SOFA)score,oxygenation index(P/F ratio),C-reactive protein(CRP),procalcitonin(PCT),interleukin 6(IL-6)and interleukin 8(IL-8).The factors affecting the prognosis of ARDS children were analyzed by multivariate Logistic regression.Receiver operating characteristic curve(ROC)was used to assess the accuracy of miR-424 in early diagnosis of sepsis complicated with ARDS,and to measure the predicative value of miR-424 on the risk of death in sepsis patients with ARDS.Results A total of 121 sepsis patients were included in this study,and 36 cases of them were complicated with ARDS.The expression level of miR-424(0.56±0.17)in the blood of sepsis patients complicated with ARDS was significantly lower than that of sepsis patients without ARDS(0.98±0.26)(t=8.776,P<0.001).The expression of miR-424 was negatively co-rrelated with IL-6(r=-0.627,P<0.01),IL-8(r=-0.651,P<0.01)and CRP(r=-0.472,P<0.05)in sepsis patients with ARDS.The expression of miR-424 was positively correlated with PCIS score(r=0.330,P<0.05),P/F ratio(r=0.592,P<0.001)and albumin(r=0.496,P<0.05)in sepsis patients with ARDS.The ROC showed that miR-424[area under curve(AUC)=0.908,95%CI:0.856-0.960]could differentiate sepsis patients with ARDS from those without ARDS.Compared with that of the survival group(0.63±0.15),miR-424 of the death group decreased significantly(0.42±0.14)(t=3.890,P<0.05).The decreased miR-424(AUC=0.845,95%CI:0.696-0.995)indicated an increased risk of death in children with ARDS.Multivariate Logistic regression analysis showed that miR-424(OR=0.001,P=0.033)and albumin(OR=0.553,P=0.040)were independent risk factors for death in ARDS children.Conclusions miR-424 can help with early diagnosis of sepsis complicated with ARDS,and can be used as a predictor of the prognosis of sepsis children complicated with ARDS.