老年脓毒症相关性脑病患者血清外泌体LncNEAT1、LncSOX2OT表达及对临床预后评价

The expression of serum extracellular vesicles LncNEAT1 and LncSOX2OT in elderly patients with sepsis related encephalopathy and their clinical prognostic evaluation

目的分析老年脓毒症相关性脑病(SAE)患者血清外泌体长链非编码RNA核富含丰富的转录本1(LncNEAT1)、长链非编码RNA SRY盒转录因子2重叠转录本(LncSOX2OT)的表达及对临床预后意义。方法选择2020年2月—2022年2月就诊于成都中医药大学附属第五人民医院重症医学科的老年SAE患者96例为SAE组,根据28 d内生存状态再分为生存亚组(n=50)和死亡亚组(n=46),以同期诊治的无SAE的脓毒症患者60例为非SAE组。采用实时荧光定量PCR(qRT-PCR)检测血清外泌体中LncNEAT1、LncSOX2OT的表达水平。多因素Logistic回归分析老年SAE患者预后的影响因素。受试者工作特征曲线(ROC)分析血清外泌体LncNEAT1、LncSOX2OT对老年SAE患者预后的诊断价值。结果SAE组血清外泌体LncNEAT1、LncSOX2OT的相对表达高于非SAE组(t/P=16.726/<0.001、21.803/<0.001)。死亡亚组SAE患者C反应蛋白、降钙素原、神经元特异性烯醇化酶、APACHEⅡ评分、SOFA评分、LncNEAT1、LncSOX2OT均高于生存亚组(t/P=14.197/<0.001,4.535/<0.001,19.253/<0.001,8.442/<0.001,5.670/<0.001,9.861/<0.001,6.931/<0.001)。SAE患者血清外泌体LncNEAT1、LncSOX2OT与APACHEⅡ评分、SOFA评分呈正相关(r/P=0.812/<0.001,0.761/<0.001,0.833/<0.001,0.598/<0.001)。降钙素原高、C反应蛋白高、神经元特异性烯醇化酶高、APACHEⅡ评分高、SOFA评分高、LncNEAT1高及LncSOX2OT高是影响SAE患者28 d生存预后的独立危险因素[OR(95%CI)=1.459(1.195~1.782)、1.464(1.164~1.841)、1.334(1.086~1.639)、1.644(1.223~2.210)、1.779(1.295~2.444)、1.347(1.050~1.728)、1.578(1.122~2.219)]。血清外泌体LncNEAT1、LncSOX2OT二者联合预测SAE患者28 d生存预后诊断的AUC为0.914,高于单项指标的0.846、0.834(Z/P=3.864/<0.001、3.915/<0.001)。结论老年SAE患者血清外泌体LncNEAT1、LncSOX2OT表达升高,是影响老年SAE患者预后的独立危险因素,并对老年SAE患者生存预后具有较高的评估价值。

Objective To analyze the expression of abundant transcript 1(LncNEAT1)and long chain non coding RNA SRY box transcription factor 2 overlapping transcript 2(LncSOX2OT)in serum extracellular vesicles of elderly sepsis associated encephalopathy(SAE)patients and their clinical prognostic significance.Methods Ninety-six elderly SAE patients who visited the Intensive Care Department of the Fifth People's Hospital Affiliated to Chengdu University of Traditional Chinese Medicine from February 2020 to February 2022 were selected as the SAE group.They were further divided into survival subgroups(n=50)and death subgroups(n=46)based on their survival status within 28 days.60 sepsis patients without SAE who were diagnosed and treated during the same period were selected as the non-SAE group.Real time fluorescence quantitative PCR(qRT-PCR)was used to detect the expression levels of LncNEAT1 and LncSOX2OT in serum extracellular vesicles.Multivariate logistic regression analysis of prognostic factors in elderly SAE patients.The diagnostic value of receiver operating characteristic curve(ROC)analysis of serum exosomes LncNEAT1 and LncSOX2OT in the prognosis of elderly SAE patients.Results The relative expression of serum extracellular vesicles LncNEAT1 and LncSOX2OT in the SAE group was higher than that in the non SAE group(t/P=16.726/<0.001,21.803/<0.001).C-reactive protein,procalcitonin,neuron specific enolase,APACHEⅡscore,SOFA score,LncNEAT1,LncSOX2OT in the death subgroup of SAE patients were higher than those in the survival subgroup(t/P=14.197/<0.001,4.535/<0.001,19.253/<0.001,8.442/<0.001,5.670/<0.001,9.861/<0.001,6.931/<0.001).The serum exosomes LncNEAT1 and LncSOX2OT in SAE patients were positively correlated with APACHE II score and SOFA score(r/P=0.812/<0.001,0.761/<0.001,0.833/<0.001,0.598/<0.001).High levels of procalcitonin,C-reactive protein,neuron specific enolase,APACHEⅡ,SOFA,LncNEAT1,and LncSOX2OT are independent risk factors affecting the 28 day survival prognosis of SAE patients[OR(95%CI)=1.459(1.195-1.782),1.464(1.164-1.841),1.334(1.086-1.639),1.644(1.223-2.210),1.779(1.295-2.444),1.347(1.050-1.728),1.578(1.122-2.219)].The combined prediction of serum extracellular vesicles LncNEAT1 and LncSOX2OT for 28 day survival prognosis in SAE patients had an AUC of 0.914,which was higher than the single indicator of 0.846 and 0.834(Z/P=3.864/<0.001,3.915/<0.001).Conclusion The increased expression of serum extracellular vesicles LncNEAT1 and LncSOX2OT in elderly SAE patients is an independent risk factor affecting the prognosis of elderly SAE patients,and has high evaluation value for the survival and prognosis of elderly SAE patients.