血清miR-183-5p和miR-339-3p水平与急性胰腺炎患者严重程度及预后的关系

Relationship between serum miR-183-5p and miR-339-3p levels and the severity and prognosis of patients with acute pancreatitis

目的探讨血清微小RNA-183-5p(miR-183-5p)和微小RNA-339-3p(miR-339-3p)水平与急性胰腺炎(AP)患者严重程度及预后的关系。方法收集2021年7月至2023年7月该院收治的175例AP患者作为AP组,根据急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分将AP患者分为轻症组108例和重症组67例,根据预后情况,分为预后良好组114例和预后不良组61例,另选取同期于该院体检的体检健康者160例作为对照组。采用实时荧光定量PCR法检测血清miR-183-5p、miR-339-3p水平,酶联免疫吸附试验测定肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)水平,Pearson相关分析AP患者血清miR-183-5p、miR-339-3p水平与TNF-α、CRP及APACHEⅡ评分的相关性,多因素Logistic回归分析AP患者预后不良的影响因素,受试者工作特征(ROC)曲线分析血清miR-183-5p、miR-339-3p水平对预后不良发生的预测价值。结果与对照组比较,AP组miR-183-5p水平升高,miR-339-3p水平降低,差异有统计学意义(t=17.497、19.113,均P<0.05)。与轻症组比较,重症组血清miR-183-5p、TNF-α、CRP、APACHEⅡ评分升高,miR-339-3p水平降低(t=10.582、5.972、11.991、13.864、2.224,均P<0.05)。AP患者血清miR-183-5p水平与TNF-α,CRP,APACHEⅡ评分呈正相关(r=0.623、0.570、0.679,均P<0.05);miR-339-3p水平与TNF-α、CRP、APACHEⅡ评分呈负相关(r=-0.655、-0.600、-0.756,均P<0.05)。预后不良组血清miR-183-5p水平高于预后良好组,miR-339-3p水平低于预后良好组,差异有统计学意义(t=5.324、5.436,均P<0.05)。TNF-α、CRP、APACHEⅡ评分、miR-183-5p是AP患者发生预后不良的独立危险因素,miR-339-3p是预后不良的保护因素(均P<0.05)。miR-183-5p、miR-339-3p水平和二者联合预测AP患者预后不良的曲线下面积分别为0.760、0.731、0.836,二者联合预测价值高于单独预测(Z=2.952、2.892,均P<0.05)。结论AP患者血清中miR-183-5p水平升高,miR-339-3p水平降低,二者与患者病情程度和预后密切相关,可能作为AP病情和预后评估的标志物。

Objective To investigate the relationship between serum microRNA-183-5p(miR-183-5p)and microRNA-339-3p(miR-339-3p)levels and the severity and prognosis of patients with acute pancreatitis(AP).Methods A total of 175 AP patients admitted to the hospital from July 2021 to July 2023 were collected as AP group.According to the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,the AP patients were divided into mild group(108 cases)and severe group(67 cases).According to the prognosis,the AP patients were divided into good prognosis group(114 cases)and poor prognosis group(61 cases).A total of 160 healthy people who underwent physical examination in the hospital during the same period were selected as the control group.The expression levels of serum miR-183-5p and miR-339-3p were detected by real-time fluorescent quantitative PCR.The levels of tumor necrosis factor(TNF)-αand C-reactive protein(CRP)were determined by enzyme-linked immunosorbent assay.Pearson correlation analysis was used to analyze the correlation of serum miR-183-5p and miR-339-3p levels with TNF-α,CRP and APACHEⅡscore in AP patients.Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in AP patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum miR-183-5p and miR-339-3p levels for poor prognosis.Results Compared with the control group,the level of miR-183-5p in the AP group was increased,and the level of miR-339-3p was decreased,the difference was statistically significant(t=17.497,19.113,all P<0.05).Compared with the mild group,the serum levels of miR-183-5p,TNF-α,CRP and APACHEⅡscore in the severe group were increased,and the level of miR-339-3p was decreased(t=10.582,5.972,11.991,13.864,2.224,all P<0.05).The level of serum miR-183-5p in AP patients was positively correlated with TNF-α,CRP and APACHEⅡscore(r=0.623,0.570,0.679,all P<0.05).The level of miR-339-3p was negatively correlated with TNF-α,CRP and APACHEⅡscore(r=-0.655,-0.600,-0.756,all P<0.05).The level of serum miR-183-5p in the poor prognosis group was higher than that in the good prognosis group,and the level of miR-339-3p was lower than that in the good prognosis group,the difference was statistically significant(t=5.324,5.436,all P<0.05).TNF-α,CRP,APACHEⅡscore,and miR-183-5p were independent risk factors for poor prognosis in AP patients,and miR-339-3p was a protective factor for poor prognosis(all P<0.05).The area under the curve of miR-183-5p,miR-339-3p levels and their combination to predict poor prognosis of AP patients was 0.760,0.731 and 0.836,respectively,and the predictive value of combined miR-183-5p and miR-339-3p was higher than that of single prediction(Z=2.952,2.892,all P<0.05).Conclusion The serum level of miR-183-5p is increased and miR-339-3p is decreased in AP patients,which are closely related to the severity and prognosis of AP patients and may be used as markers for the evaluation of the condition and prognosis of AP.