急性胰腺炎患者血清miR-25-3p、TLR4水平变化及其临床意义

Changes of serum miR-25-3p and TLR4 levels in patients with acute pancreatitis and their clinical significance

目的检测血清微RNA(microRNA,miR)-25-3p,Toll样受体4(Toll-like receptor 4,TLR4)的表达水平,并讨论两者与急性胰腺炎(acute pancreatitis,AP)患者预后的关系。方法选取2019年3月至2021年3月丽水市第二人民医院收治的178例AP患者作为AP组,同期体检的健康者100例作为对照组。AP组根据病情分为轻型急性胰腺炎(mild acute pancreatitis,MAP)组(n=95)和重症急性胰腺炎(severe acute pancreatitis,SAP)组(n=83),根据治疗后3个月预后情况分为生存组(n=148)和死亡组(n=30)。比较miR-25-3p、TLR4在各组患者血清中的表达水平,分析miR-25-3p与TLR4表达水平的相关性,采用多因素Logistic回归分析AP患者预后的影响因素,受试者操作特征(receiver operator characteristic,ROC)曲线分析血清miR-25-3p、TLR4预测AP患者预后的价值。结果AP组血清miR-25-3p表达水平明显低于对照组,TLR4表达水平明显高于对照组,差异均有统计学意义(P<0.05)。SAP组血清miR-25-3p表达水平明显低于MAP组,TLR4表达水平明显高于MAP组,差异均有统计学意义(P<0.05)。AP组miR-25-3p表达水平与TLR4呈负相关(r=-0.731,P<0.001)。生存组的血清miR-25-3p表达水平明显高于死亡组,而TLR4表达水平明显低于死亡组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,脂肪酶、急性生理与慢性健康评分Ⅱ(acute physiological and chronic health evaluation-Ⅱ,APACHEⅡ)评分及miR-25-3p为AP患者预后的影响因素。ROC结果显示,血清miR-25-3p、TLR4及联合预测AP预后死亡的曲线下面积为0.844[95%置信区间(confidence interval,CI):0.784~0.904、0.835(95%CI:0.734~0.936)及0.914(95%CI:0.861~0.967)。结论AP患者血清miR-25-3p表达水平降低,TLR4表达水平升高,二者均与病情严重程度及预后有关,联合检测其表达水平有助于评估预后。

Objective To detect the expression levels of serum micro-RNA-25-3p(miR-25-3p)and Toll-like receptor 4(TLR4),and to discuss the relationship between the two and the prognosis of patients with acute pancreatitis(AP).Methods A total of 178 patients with AP admitted to Lishui Second People's Hospital from March 2019 to March 2021 were selected as the AP group,and 100 healthy individuals who were examined during the same period were used as the control group.the AP group was divided into mild acute pancreatitis(MAP)group(n=95)and severe acute pancreatitis(SAP)group(n=83)according to their conditions.and the survival group(n=148)and death group(n=30)according to the prognosis at 3 months after treatment.The expression levels of miR-25-3p and TLR4 in the serum of patients in each group were compared,the correlation between miR-25-3p and TLR4 expression levels was analyzed,and the factors influencing the prognosis of AP patients were analyzed using multi-factor Logistic regression,and the value of serum miR-25-3p and TLR4 in predicting the prognosis of AP patients was analysed using receiver operator characteristic(ROC)curves.Results The expression level of serum miR-25-3p in AP group was significantly lower than that in normal control group,and the expression level of TLR4 was significantly higher than that in normal control group(P<0.05).The expression level of serum miR-25-3p in the SAP group was significantly lower than that in the MAP group,and the expression level of TLR4 was significantly higher than that in the MAP group(P<0.05).miR-25-3p was negatively correlated with TLR4 in AP group patients (r=-0.731, P<0.001). The expression level of miR-25-3p in the survival group was significantly higher than that in the death group, while the level of TLR4 was significantly lower than that in the death group (P<0.05). Regression analysis showed that lipase, acute physio-logical and chronic health evaluation-Ⅱ (APACHEⅡ) score and miR-25-3p were the prognostic factors of AP patients. The ROC results showed that the areas under the curve of serum miR-25-3p, TLR4 and their combination predicting the prognosis of AP death were 0.844 [95% confidence interval (CI): 0.784-0.904], 0.835 (95%CI: 0.734-0.936) and 0.914 (95%CI: 0.861-0.967). Conclusion The expression level of serum miR-25-3p in patients with acute pancreatitis is decreased, and the expression level of TLR4 is increased, both of which were related to the severity of the disease and prognosis. The combined detection of their expression levels is helpful to evaluate the prognosis.