慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者血清miR-221-3p和miR-149-3p表达水平及其与预后的相关性分析

Expression Levels of Serum miR-221-3p and miR-149-3p in Patients with Chronic Obstructive Pulmonary Disease Complicated by Type II Respiratory Failure and Their Correlation with Prognosis

目的分析慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者血清微小核糖核酸(micro RNA,miR)-221-3p和miR-149-3p水平变化及其与预后的相关性。方法选取2019年4月~2021年10月在江油市人民医院治疗的180例慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者作为研究对象,根据一年后随访结果分为生存组(n=120)和死亡组(n=60)。采用实时荧光定量PCR(qRT-PCR)法检测患者血清中miR-221-3p和miR-149-3p的相对表达水平,并对生存组、死亡组患者血清miR-221-3p和miR-149-3p水平进行比较。Spearman法分析miR-221-3p,miR-149-3p与急性生理和慢性健康评分Ⅱ(APACHEⅡ)的相关性。对影响慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者预后的因素进行Logistic回归分析;受试者工作特征(ROC)曲线分析miR-221-3p和miR-149-3p的表达对慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者预后的预测价值。结果生存组血清miR-221-3p,miR-149-3p表达水平和APACHEⅡ评分分别为1.02±0.18,1.01±0.21和12.80±4.45分;死亡组慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者血清miR-221-3p,miR-149-3p表达水平和APACHEⅡ评分分别为1.54±0.36,0.66±0.16和27.45±6.05分;与生存组相比,死亡组患者血清miR-221-3p表达水平、APACHEⅡ评分均明显升高(t=12.938,18.395,P<0.01),miR-149-3p表达水平显著降低(t=11.360,P<0.01),差异均有统计学意义;慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者血清miR-221-3p水平与APACHEⅡ评分呈正相关(r=0.509,P<0.05),miR-149-3p水平与APACHEⅡ评分呈负相关(r=-0.470,P<0.05);Logistic回归分析发现吸烟(OR=3.216,95%CI:1.112~9.304)、高APACHEⅡ评分(OR=1.355,95%CI:1.054~1.741)、高血清miR-221-3p水平(OR=4.264,95%CI:1.772~10.260)是影响慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者预后的危险因素(P<0.05),高血清miR-149-3p水平(OR=0.198,95%CI:0.078~0.503)是影响患者预后的保护因素(P<0.01);经ROC曲线分析,血清miR-221-3p,miR-149-3p及二者联合预测慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者预后的曲线下面积(AUC)分别为0.889,0.860和0.959,二者联合检测优于其各自单独预测(Z=2.174,3.225,P=0.015,<0.01)。结论慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者血清miR-221-3p水平升高,miR-149-3p水平降低,与患者预后有关,能够预测慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭患者的预后。

Objective To analyse the changes in serum micro ribonucleic acid(miR)-221-3p and micro ribonucleic acid(miR)-149-3p levels in patients with chronic obstructive pulmonary disease(COPD)complicated by type II respiratory failure and their correlation with prognosis.Methods A total of 180 patients with COPD complicated by type II respiratory failure who were treated in Jiangyou People’s Hospital from April 2019 to October 2021 were selected as the study subjects.The patients were divided into survival group(n=120)and death group(n=60)according to the follow-up results after one year.The relative expression levels of miR-221-3p and miR-149-3p in serum of patients were detected by real-time fluorescent quantitative PCR(qRT-PCR),and compared between patients in survival group and death group.Spearman method was used to analyze the correlation between miR-221-3p,miR-149-3p and Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore.Logistic regression analysis was used to analyze the factors affecting the prognosis of patients with COPD and type II respiratory failure,and the predictive value of the expression of miR-221-3p and miR-149-3p on the prognosis of patients with COPD and type II respiratory failure was analyzed by ROC curve.Results The expression level of serum miR-221-3p,miR-149-3p and APACHEⅡscore in survival group were 1.02±0.18,1.01±0.21and 12.80±4.45,respectively.The expression level of serum miR-221-3p,miR-149-3p and APACHEⅡscore in the death group were 1.54±0.36,0.66±0.16 and 27.45±6.05,respectively.Compared with the survival group,the expression level of serum miR-221-3p and APACHEⅡscore in the death group were greatly higher(t=12.938,18.395,P<0.01),the expression level of miR-149-3p was greatly lower(t=11.360,P<0.01).There was a positive correlation between the serum miR-221-3p level and APACHEⅡscore in patients with COPD complicated by type II respiratory failure(r=0.509,P<0.05),the level of miR-149-3p was negatively correlated with APACHEⅡscore(r=-0.470,P<0.05).Logistic regression analysis showed that smoking(OR=3.216,95%CI:1.112~9.304),high APACHEⅡscore(OR=1.355,95%CI:1.054~1.741)and high serum miR-221-3p level(OR=4.264,95%CI:1.772~10.260)were risk factors affecting the prognosis of COPD complicated by type II respiratory failure(P<0.05),and high serum miR-149-3p level(OR=0.198,95%CI:0.078~0.503)was a protective factor affecting the prognosis(P<0.01).The area under the curve(AUC)of serum miR-221-3p,miR-149-3p and both of them to predict the prognosis of patients with COPD combined with type II respiratory failure were 0.889,0.860 and 0.959,respectively,and their combination was better than individual predictions(Z=2.174,3.225,P=0.015,<0.01).Conclusion The level of serum miR-221-3p in patients with COPD and type II respiratory failure was elevated,the level of miR-149-3p was decreased,and they were related to the prognosis of patients,and can predict the prognosis of patients with COPD complicated by type II respiratory failure.