血清微小RNA-7a-5p及前蛋白转化酶枯草溶菌素9水平与急性胰腺炎患者病情严重程度及预后的关系

Relationship of serum microRNA-7a-5p and proprotein convertase subtilisin/Kexin type 9 levels to the severity and prognosis of patients with acute pancreatitis

目的分析血清微小RNA-7a-5p(miR-7a-5p)、前蛋白转化酶枯草溶菌素9(PCSK9)水平与急性胰腺炎(AP)患者病情严重程度及预后的关系。方法选取2020年1月至2022年1月重庆医科大学附属巴南医院收治的185例AP患者为AP组,另选取同期本院体检健康者53例为对照组。AP患者根据病情严重程度分为轻症组(81例)、中度重症组(53例)、重症组(51例)。收集AP患者的临床资料,检测所有受试者血清miR-7a-5p、PCSK9水平。分析AP患者预后不良的危险因素以及血清miR-7a-5p、PCSK9水平单独与联合预测AP患者预后不良的价值。结果AP组血清miR-7a-5p、PCSK9水平均高于对照组,差异均有统计学意义(均P<0.001)。轻症组、中度重症组、重症组血清miR-7a-5p、PCSK9水平逐渐升高[miR-7a-5p:(2.12±0.43)、(2.51±0.33)、(3.00±0.43);PCSK9:(36.1±2.6)、(38.6±2.2)、(41.3±2.2)μg/L],差异均有统计学意义(均P<0.001)。多因素Logistic回归分析显示,重症AP、重症监护病房停留时间延长和红细胞体积分布宽度、血肌酐、C反应蛋白、miR-7a-5p、PCSK9水平升高为AP患者预后不良的独立危险因素(均P<0.05)。受试者工作特征曲线分析显示,血清miR-7a-5p、PCSK9水平单独与联合预测AP患者预后不良的曲线下面积分别为0.780、0.773、0.877,二者联合预测AP患者预后不良的曲线下面积大于单独预测(均P<0.05)。结论AP患者血清miR-7a-5p、PCSK9水平升高与病情严重程度和预后不良有关,二者联合对AP患者预后不良的辅助预测价值较高。

Objective To analyze the relationship of serum microRNA-7a-5p(miR-7a-5p)and proprotein convertase subtilisin/Kexin type 9(PCSK9)levels to the severity and prognosis of patients with acute pancreatitis(AP).Methods Totally 185 patients with AP were selected as AP group in Banan Hospital Affiliated to Chongqing Medical University from January 2020 to January 2022.Another 53 cases of physical examination healthy persons in the hospital were selected as control group.Patients with AP were divided into mild disease group(81 cases),moderately severe disease group(53 cases)and severe disease group(51 cases)according to their severity.Clinical data of patients with AP were recorded and serum miR-7a-5p and PCSK9 levels were measured in all subjects.Risk factors for poor prognosis in patients with AP,and the value of serum miR-7a-5p and PCSK9 levels alone and in combination to predict poor prognosis were analyzed.Results Serum miR-7a-5p and PCSK9 levels were higher in AP group than those in control group(both P<0.001).Serum miR-7a-5p and PCSK9 levels gradually increased in the mild disease group,moderately severe disease group and severe disease group[miR-7a-5p:(2.12±0.43),(2.51±0.33),(3.00±0.43);PCSK9:(36.1±2.6),(38.6±2.2),(41.3±2.2)μg/L](both P<0.001).Multivariate Logistic regression analysis showed that severe AP,prolonged intensive care unit stay and increased levels of red cell volume distribution width,serum creatinine,C-reactive protein,miR-7a-5p and PCSK9 were independent risk factors for poor prognosis in patients with AP(all P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve(AUC)of serum miR-7a-5p and PCSK9 levels alone and in combination to predict poor prognosis in patients with AP were 0.780,0.773 and 0.877,respectively,and the AUC of serum miR-7a-5p and PCSK9 in combination was greater than each indicator individually(both P<0.05).Conclusion The increase of serum miR-7a-5p and PCSK9 levels in patients with AP is associated with severity of disease and poor prognosis,and the combination of the two indicators has a high adjunctive predictive value for poor prognosis in patients with AP.