血浆miR-128-3p在重症胰腺炎患者中的表达及临床意义

Expression change and clinical significance of plasma miR-128-3p in patients with severe pancreatitis

目的检测微小RNA-128-3p(miR-128-3p)在重症胰腺炎(severe pancreatitis,SAP)患者血浆中的表达情况及临床意义。方法选择2017年6月至2020年12月在上海市宝山区中西医结合医院就诊的SAP患者175例为观察对象,根据患者严重程度分级,将患者分为轻症急性胰腺炎(mild acute pancreatitis,MAP)组78例,中重症急性胰腺炎(moderate to severe acute pancreatitis,MSAP)组50例和SAP组47例。根据患者预后情况,将SAP组分为存活组28例和死亡组19例。qRT-PCR法检测miR-128-3p水平,对患者进行急性生理健康与慢性疾病(APACHEⅡ)评分、Ranson评分,pearson分析血浆miR-128-3p水平与APACHEⅡ、Ranson评分相关性,ROC曲线分析血浆miR-128-3p对SAP患者预后不良的预测价值。结果MAP组、MSAP组、SAP组3组间APACHEⅡ[(3.41±1.56)、(5.63±1.78)、(6.57±1.83)分]、Ranson[(2.58±1.34)、(4.95±1.47)、(6.06±1.92)分]评分及血浆CRP[(39.73±12.31)、(70.25±24.38)、(142.51±40.55)mg/L]、血钙[(1.95±0.31)、(13.26±5.24)、(14.21±6.32)mmol/L]水平比较,差异有统计学意义(P<0.05);与MAP组(1.05±0.12)比较,MSAP组(0.83±0.08)与SAP组(0.57±0.05)患者血浆miR-128-3p表达水平显著降低(P<0.05);与MSAP组(0.83±0.08)比较,SAP组(0.57±0.05)患者血浆miR-128-3p表达水平显著降低(P<0.05);与存活组[(0.65±0.08)、(5.91±1.64)分、(5.45±1.25)分、(120.43±30.56)mg/L]比较,死亡组SAP患者血浆miR-128-3p(0.43±0.05)表达水平显著降低,APACHEⅡ[(7.43±2.21)分]、Ranson评分[(7.22±1.59)分]及血浆CRP水平[(171.52±42.38)mg/L]显著升高(P<0.05)。相关性分析结果显示,血浆miR-128-3p水平与APACHEⅡ、Ranson评分呈负相关性(r=-0.531,-0.609,P<0.05);血浆miR-128-3p预测SAP患者预后不良诊断效能优于APACHEⅡ、Ranson评分、CRP。结论SAP患者血浆miR-128-3p水平降低,对SAP的诊断与预后评估具有一定价值。

Objective To detect the expression and clinical significance of microRNA-128-3p(miR-128-3p)in the plasma of patients with severe pancreatitis(SAP).Methods A total of 175 patients with acute pancreatitis who were treated in our hospital from Jun.2017 to Dec.2020 were selected as observation objects.According to the severity of the patients,the patients were divided into 78 cases in mild acute pancreatitis(MAP)group,50 cases in moderate to severe acute pancreatitis(MSAP)group and 47 cases in severe acute pancreatitis(SAP)group;according to the patient’s prognosis,the SAP group was divided into 28 cases in the survival group and 19 cases in the death group.The level of miR-128-3p was detected by qRT-PCR method,and patients were evaluated with Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score and Ranson score,the correlation between plasma miR-128-3p level and APACHEⅡ,Ranson score was analyzed by Pearson,the predictive value of plasma miR-128-3p for poor prognosis of SAP patients was analyzed by ROC curve.Results There were statistically significant differences in APACHE Ⅱ[(3.41±1.56),(5.63±1.78),(6.57±1.83)points],Ranson[(2.58±1.34),(4.95±1.47),(6.06±1.92)points]and plasma CRP[(39.73)±12.31),(70.25±24.38),(142.51±40.55)mg/L],serum calcium[(1.95±0.31),(13.26±5.24),(14.21±6.32)mmol/L],among the MAP group,MSAP group and SAP group(P<0.05);Compared with the MAP group(1.05±0.12),the plasma miR-128-3p expression levels in the MSAP group(0.83±0.08)and the SAP group(0.57±0.05)were significantly decreased(P<0.05);compared with the MSAP group(0.83±0.08)Compared with the SAP group(0.57±0.05),the plasma miR-128-3p expression level was significantly decreased(P<0.05);Compared with the survival group[(0.65±0.08),(5.91±1.64)points,(5.45±1.25)points,(120.43±30.56)mg/L],the plasma miR-128-3p of SAP patients in the death group was(0.43±0.05)expression levels were significantly reduced,APACHE Ⅱ[(7.43±2.21)points],Ranson score[(7.22±1.59)points]and plasma CRP level[(171.52±42.38)mg/L]were significantly increased(P<0.05);the results of correlation analysis showed that plasma miR-128-3p level was negatively correlated with APACHEⅡand Ranson scores(r=-0.531,-0.609,P<0.05);The diagnostic efficacy of plasma miR-128-3p in predicting poor prognosis of SAP patients is better than APACHEⅡ,Ranson score,and CRP.Conclusion Plasma miR-128-3p level is elevated in patients with severe pancreatitis,which is of certain value for the diagnosis and prognostic evaluation of SAP.