miR-21水平与ICU脓毒症患者T淋巴细胞亚群指标的关系及在多重耐药菌感染防治中的价值

Relationship between miR-21 level and T lymphocyte subsets in patients with sepsis in ICU and its value in the prevention and treatment of multi-drug resistant organism infection

目的探讨微小RNA(miRNA)-21(miR-21)与重症监护病房(ICU)脓毒症患者T淋巴细胞亚群指标间的关系,并分析其对防治多重耐药菌(MDRO)感染的价值。方法选取2020年1月至2022年5月ICU脓毒症患者125例为研究对象,其中一般脓毒症患者73例,脓毒症休克患者52例。检测纳入研究者血清miR-21水平及T淋巴细胞亚群指标(CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞百分比和CD4^(+)/CD8^(+)比值),分析miR-21水平与T淋巴细胞亚群指标的相关性。统计ICU脓毒症患者MDRO感染情况,分析患者MDRO感染的影响因素,构建风险模型。结果脓毒症休克患者血清miR-21水平、CD8^(+)T淋巴细胞百分比高于一般脓毒症患者,CD3^(+)T淋巴细胞百分比、CD4^(+)T淋巴细胞百分比、CD4^(+)/CD8^(+)比值低于一般脓毒症患者,差异均有统计学意义(P<0.05)。ICU脓毒症患者血清miR-21水平与CD3^(+)T淋巴细胞百分比、CD4^(+)T淋巴细胞百分比、CD4^(+)/CD8^(+)比值呈负相关(r=-0.842、-0.788、-0.825,P<0.001),与CD8^(+)T淋巴细胞百分比呈正相关(r=0.818,P<0.001)。校正机械通气、住ICU时间、使用糖皮质激素等因素后,合并慢性阻塞性肺疾病、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、抗菌药物使用频率、抗菌药物持续使用时间、miR-21为ICU脓毒症患者发生MDRO感染的独立影响因素(P<0.05)。ICU脓毒症患者MDRO感染的风险模型显示,MDRO感染风险得分>8分患者感染风险最高,感染率为66.67%。结论ICU脓毒症患者miR-21表达与T淋巴细胞亚群指标密切相关,而且miR-21高表达会增加MDRO感染风险,检测血清miR-21水平对MDRO感染防治具有重要指导意义。

Objective To investigate the relationship between microRNA(miRNA)-21(miR-21)and T lymphocyte subsets in patients with sepsis in intensive care unit(ICU),and to analyze its significance for the prevention and treatment of multi-drug resistant organism(MDRO)infection.Methods A total of 125 patients with sepsis in ICU from January 2020 to May 2022 were enrolled in the study,including 73 patients with general sepsis and 52 patients with septic shock.The level of serum miR-21 and T lymphocyte subsets indexes(CD3^(+),CD4^(+),CD8^(+)T cell percentages and CD4^(+)/CD8^(+)ratio)were measured,and the correlation between miR-21 level and T lymphocyte subsets indexes was analyzed.The situation of MDRO infection in ICU septic patients was counted,the influencing factors of MDRO infection were analyzed,and the risk model was constructed.Results The level of serum miR-21 and the percentage of CD8^(+)T cells in septic shock patients were higher than those in general sepsis patients,and the percentage of CD3^(+)T cells,CD4^(+)T cells and CD4^(+)/CD8^(+)ratio were lower than those in general sepsis patients,and the differences were statistically significant(P<0.05).The serum level of miR-21 in ICU patients with sepsis was negatively correlated with the percentage of CD3^(+)T cells,CD4^(+)T cells,and CD4^(+)/CD8^(+)ratio(r=-0.842,-0.788,-0.825,P<0.001),and positively correlated with the percentage of CD8^(+)T cells(r=0.818,P<0.001).After adjusting for factors such as mechanical ventilation,length of ICU stay,and use of glucocorticoids,chronic obstructive pulmonary disease,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,frequency of antibiotic use,duration of antibiotic use,and miR-21 were independent influencing factors for MDRO infection in ICU septic patients(P<0.05).The risk model of MDRO infection in ICU septic patients showed that patients with MDRO infection risk score>8 had the highest risk of infection,and the infection rate was 66.67%.Conclusion The expression of miR-21 in ICU patients with sepsis is closely related to T lymphocyte subsets,and the high expression of miR-21 will increase the risk of MDRO infection.Detection of serum miR-21 level has great value in the prevention and treatment of MDRO infection.