老年重症肺炎病人血清微小RNA-146a、微小RNA-223、微小RNA-21、微小RNA-124水平及其与预后的关系

Serum levels of miR-146a, miR-223, miR-21, and miR-124 in elderly patients with severe pneumonia and their relationship with prognosis

目的 探究老年重症肺炎病人血清微小RNA(miR)-146a、miR-223、miR-21、miR-124表达水平及其与预后的关系。方法选取2018年2月至2020年3月郑州大学第二附属医院诊治的128例老年重症肺炎病人、130例普通肺炎病人分别为重症肺炎组、普通肺炎组,并纳入同期128例体检健康者为健康组。比较三组血清miR-146a、miR-223、miR-21、miR-124表达水平及肿瘤坏死因子-α(TNF-α)水平;分析老年重症肺炎病人血清miR-146a、miR-223、miR-21、miR-124表达水平与TNF-α的相关性;比较不同预后老年重症肺炎病人临床资料和血清miR-146a、miR-223、miR-21、miR-124水平;分析老年重症肺炎病人死亡的影响因素;分析血清miR-146a、miR-223、miR-21、miR-124、TNF-α对老年重症肺炎病人预后的预测价值。结果 普通肺炎组病人血清miR-146a、miR-223、miR-21表达水平及TNF-α水平分别为1.67±0.56、1.64±0.55、1.71±0.57、(12.78±4.30)ng/L,重症肺炎组病人血清miR-146a、miR-223、miR-21表达水平及TNF-α水平分别为2.32±0.78、2.27±0.76、2.39±0.80、(23.64±7.92)ng/L,高于健康组的1.03±0.35、1.01±0.34、0.99±0.33、(5.43±1.84)ng/L、(P<0.05),普通肺炎组、重症肺炎组血清miR-124表达水平分别为0.71±0.24、0.37±0.13,低于健康组的1.07±0.37(P<0.05);重症肺炎组病人血清miR-146a、miR-223、miR-21表达水平及TNF-α水平高于普通肺炎组(P<0.05),血清miR-124表达水平低于普通肺炎组(P<0.05);老年重症肺炎病人血清miR-146a、miR-223、miR-21表达水平与TNF-α呈正相关(P<0.05),血清miR-124表达水平与TNF-α呈负相关(P<0.05);死亡组老年重症肺炎病人血清miR-146a、miR-223、miR-21、TNF-α水平及有呼吸系统疾病史、吸烟史、机械通气占比高于生存组(P<0.05),血清miR-124表达水平、氧分压水平低于生存组(P<0.05);miR-146a、miR-223、miR-21、TNF-α、机械通气是老年重症肺炎病人死亡的危险因素(P<0.05);血清miR-146a、miR-223、miR-21、miR-124、TNF-α预测老年重症肺炎病人预后的曲线下面积(AUC)分别为0.84、0.88、0.82、0.66、0.68,其灵敏度分别为72.5%、80.4%、82.4%、60.8%、60.8%,特异度分别为85.7%、81.8%、79.2%、67.5%、72.4%。结论 老年重症肺炎病人血清miR-146a、miR-223、miR-21表达水平较高,与TNF-α水平呈正相关;miR-124表达水平较低,与TNF-α水平呈负相关。且测定血清miR-146a、miR-223、miR-21表达水平有助于临床预测老年重症肺炎病人的预后情况。

Objective To investigate the expression levels of serum microRNA(miR)-146a,miR-223,miR-21 and miR-124 in elderly patients with severe pneumonia and their relationship with prognosis.Methods A total of 128 elderly patients with severe pneumonia and 130 patients with common pneumonia who were treated at the Second Affiliated Hospital of Zhengzhou University from February 2018 to March 2020 were selected as the severe pneumonia group and the common pneumonia group,respectively,and 128 healthy individuals with physical examination during the same period were included as the healthy group.The serum expression levels of miR-146a,miR-223,miR-21,miR-124 and tumor necrosis factor-α(TNF-α) were compared in the three groups.We analyzed the correlation between serum miR-146a,miR-223,miR-21,miR-124 expression levels and TNF-α in elderly severe pneumonia patients;compared the clinical data and serum levels of miR-146a,miR-223,miR-21,and miR-124 in elderly severe pneumonia patients with different prognoses;analyzed the influencing factors of death in elderly severe pneumonia patients;and analyzed the predictive value of serum miR-146a,miR-223,miR-21,miR-124 and TNF-α on the prognosis of elderly severe pneumonia patients.Results The expression levels of serum miR-146a,miR-223,miR-21 and TNF-α in patients with common pneumonia were 1.67±0.56,1.64±0.55,1.71±0.57 and(12.78±4.30) ng/L,respectively,while those in patients with severe pneumonia were 2.32±0.78,2.27±0.76,2.39±0.80 and(23.64±7.92) ng/L,respectively,which were higher than those in the healthy group [1.03±0.35,1.01±0.34,0.99±0.33,(5.43±1.84) ng/L](P<0.05).The expression levels of serum miR-124 in the common pneumonia group and severe pneumonia group were 0.71±0.24 and 0.37±0.13,respectively,which were lower than those in the healthy group(1.07±0.37)(P<0.05).The expression levels of serum miR-146a,miR-223,miR-21 and TNF-α in the severe pneumonia group were higher than those in the common pneumonia group(P<0.05),and the expression level of serum miR-124 was lower than that in the common pneumonia group(P<0.05).The expression levels of serum miR-146a,miR-223,and miR-21 in elderly severe pneumonia patients were positively correlated with TNF-α(P<0.05),and the expression level of serum miR-124 was negatively correlated with TNF-α(P<0.05).The expression levels of serum miR-146a,miR-223,miR-21,and TNF-α and the history of respiratory diseases,smoking history,and proportion of mechanical ventilation of elderly sewere pneumonia patients in the death group were higher than those in the survival group(P<0.05),and the expression level of serum miR-124 and the level of oxygen partial pressure were lower than those in the survival group(P<0.05).The miR-146a,miR-223,miR-21,TNF-α,and mechanical ventilation were risk factors for death in elderly severe pneumonia patients(P<0.05).The areas under the curve(AUCs) of serum miR-146a,miR-223,miR-21,miR-124,and TNF-α for predicting prognosis in elderly severe pneumonia patients were 0.84,0.88,0.82,0.66,and 0.68,respectively,with sensitivities of 72.5%,80.4%,82.4%,60.8% and 60.8%,respectively,and specificities were 85.7%,81.8%,79.2%,67.5% and 72.4%,respectively.Conclusions The expression levels of serum miR-146a,miR-223 and miR-21 in elderly patients with severe pneumonia were higher and positively correlated with TNF-α levels;the expression level of miR-124 was lower and negatively correlated with TNF-α levels.The measurement of serum miR-146a,miR-223 and miR-21 expression levels could help to predict the prognosis of elderly patients with severe pneumonia clinically.