血清miR-338-3p联合肺部超声评分预测急性呼吸窘迫综合征新生儿的预后价值

Predictive value of serum miR-338-3p and lung ultrasound score for prognosis of neonatal acute respiratory distress syndrome

目的探讨血清miR-338-3p、肺部超声评分(LUS)对新生儿呼吸窘迫综合征(ARDS)预后价值。方法选择2019年5月至2022年5月在深圳市宝安区石岩人民医院收治的120例ARDS新生儿作为ARDS组,其中男性76例,女性44例;胎龄28~40周,平均胎龄32.32周;出生体质量1.68~3.89 kg,平均出生体质量2.18 kg;新生儿Apgar评分4~8分,平均Apgar评分6.37分;分娩方式,顺产43例,剖宫产57例;病因,脓毒症10例,早产29例,肺炎25例,胎粪吸入综合征21例,其他15例。选择同时期50例正常新生儿为对照组,其中男性34例,女性16例;胎龄31~40周,平均胎龄33.04周;出生体质量1.94~4.02 kg,平均出生体质量2.74 kg;分娩方式,顺产17例,剖宫产33例。ARDS新生儿根据预后分为生存组与死亡组,根据胸部X射线片结果分为轻度组与重度组。实时定量聚合酶链式反应(qPCR)检测血浆miR-338-3p水平,进行床旁肺部LUS及新生儿急性生理学评分围生期补充Ⅱ(SNAPPE-Ⅱ)评分。比较各组血浆miR-338-3p水平、LUS。Pearson相关性分析SNAPPE-Ⅱ与miR-338-3p、LUS的相关性。受试者工作特性(ROC)曲线分析miR-338-3p、LUS对ARDS新生儿死亡的预测价值。采用Logistic回归分析法分析miR-338-3p水平、LUS与ARDS新生儿预后的关系。结果ARDS新生儿LUS高于正常新生儿[(29.45±3.42)分vs(10.04±2.01)分],血浆miR-338-3p水平低于正常新生儿[(10.04±2.01)分vs(1.12±0.11)分](P<0.001)。重度组LUS、SNAPPE-Ⅱ评分高于轻度组[(34.27±4.25)分vs(18.97±2.11)分、(31.84±3.52)分vs(18.56±2.85)分],miR-338-3p水平低于轻度组[(0.28±0.02)vs(0.96±0.04)](P<0.001)。SNAPPE-Ⅱ评分与LUS呈正相关(r=0.971,P<0.001),与miR-338-3p水平呈负相关(r=-0.918,P<0.001)。死亡组新生儿LUS高于生存组,miR-338-3p水平低于生存组[(37.02±3.63)分vs(20.77±3.02)分、(0.33±0.02)vs(0.75±0.02)。P<0.001]。LUS评分、血浆miR-338-3p及两者联合预测ARDS新生儿预后的曲线下面积(AUC)分别为0.851、0.835、0.929。血浆miR-338-3p、LUS是影响ARDS新生儿预后的危险因素(均P<0.05)。结论ARDS新生儿血清miR-338-3p低表达,LUS升高,两者可预测ARDS新生儿病情程度、预后。

Objective To explore the predictive value of serum miR-338-3p and lung ultrasound score(LUS)for prognosis of neonatal acute respiratory distress syndrome(ARDS).Methods From May 2019 to May 2022,a total of 120 neonatal patient with ARDS(ARDS group)were enrolled,which included 76 males and 44 females,gestational aged 28-40 weeks with mean gestational age of 32.32 weeks;birth body mass was 1.68-3.89 kg with mean body mass of 2.18 kg;neonatal Apgar score was 4-8 scores with mean score of 6.37 scores.There were 43 cases of spontaneous delivery and 57 of cesarean section.Among them,the etiology were 10 cases of sepsis,29 of premature delivery,25 of pneumonia,21 of meconium aspiration syndrome and 15 of other diseases.At the same period,50 normal newborns were enrolled as control group,which included 34 males and 16 females,gestational aged 31-40 weeks with mean gestational age of 33.04 weeks;birth body mass was 1.94-4.02 kg with mean body mass of 2.74 kg.There were 17 cases of spontaneous delivery and 33 of cesarean section.The neonatal patient with ARDS were divided into survival group and death group according to prognosis,while were divided into mild group and severe group according to results of chest X-ray.The real-time quantitative polymerase chain reaction(qPCR)was used to detect plasma level of miR-338-3p,and bedside LUS and neonatal acute physiology score perinatal supplementⅡ(SNAPPE-Ⅱ)were performed.The plasma miR-338-3p level and LUS were compared in different groups,Pearson correlation analysis was used to analyze the correlation between SNAPPE-Ⅱand plasma level of miR-338-3p,and LUS.The receiver operating characteristic(ROC)curve and Logistic regression analysis was used to ana-lyze the value of miR-338-3p and LUS for death or prognosis in neonatal patient with ARDS,respectively.Results The LUS of neonatal patient with ARDS was significantly higher than that of normal newborns[(29.45±3.42)scores vs(10.04±2.01)scores],and plasma miR-338-3p level was remarkably lower than that of normal newborns[(10.04±2.01)scores vs(1.12±0.11)scores](t=37.48,53.38,P<0.001).The LUS and SNAPPE-Ⅱscore of severe group were significantly higher than those of mild group[(34.27±4.25)scores vs(18.97±2.11)scores,(31.84±3.52)scores vs(18.56±2.85)scores],and miR-338-3p level was significantly lower than that of mild group(0.28±0.02 vs 0.96±0.04)(P<0.001).The SNAPPE-Ⅱscore was positively correlat ed with LUS(r=0.971,P<0.001),and negatively correlated with miR-338-3p level(r=-0.918,P<0.001).The LUS of death group was higher than that in survival group,and miR-338-3p level was remarkably lower than that in survival group[(37.02±3.63)scores vs(20.77±3.02)scores,(0.33±0.02)scores vs(0.75±0.02)scores.P<0.001].The area under curve(AUC)of LUS,plasma miR-338-3p and their combination in predicting prognosis of neonatal patient with ARDS were 0.851,0.835 and 0.929,respectively.The plasma miR-338-3p and LUS were risk factors affecting the prognosis of ARDS patients(P<0.05).Conclusion It is demonstrated that low-expression of miR-338-3p in serum of neonatal patient with ARDS and elevated LUS can predict the severity and prognosis of ARDS.