血清miR-34a及Ang-1水平变化与新生儿呼吸窘迫综合征患儿预后关系研究

Relationship between changes of serum miR-34a and Ang-1 levels and prognosis of neonatal children with respiratory distress syndrome

目的探讨血清微小核糖核酸-34a(miR-34a)及血管生成素-1(Ang-1)水平变化与新生儿呼吸窘迫综合征(NRDS)患儿预后关系。方法选取2020年1月至2022年12月邯郸市中心医院收治的NRDS患儿178例作为研究对象,纳入NRDS组,另外选取健康新生儿178例作为对照组。比较两组血清miR-34a及Ang-1水平变化。以新生儿确诊NRDS为起点,根据预后情况将患儿分为生存组(n=140)和死亡组(n=38),采用Logistic回归模型分析影响NRDS患儿死亡的相关因素,并用受试者工作特征曲线(ROC)分析血清miR-34a、Ang-1对NRDS患儿死亡的预测价值。结果NRDS组血清miR-34a表达水平高于对照组,Ang-1水平则低于对照组,差异有统计学意义(P<0.05)。死亡组剖宫产占比、凶险型前置胎盘占比、白细胞计数、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肌钙蛋白-Ⅰ、SNAPPEⅡ评分及血清miR-34a表达水平高于生存组,Ang-1水平则低于生存组,差异有统计学意义(P<0.05)。Logistic回归分析模型显示,血清miR-34a表达水平、SNAPPEⅡ评分、IL-6水平偏高,Ang-1水平偏低均是影响NRDS患儿死亡的危险因素(P<0.05)。ROC曲线分析显示,血清miR-34a及Ang-1单项预测NRDS患儿死亡的AUC(95%CI)分别为0.770(0.702~0.830)、0.808(0.742~0.863),采用LogP模式拟合联合诊断,结果显示联合诊断AUC(95%CI)为0.887(0.815~0.939),高于任一单项检测(P<0.05)。结论NRDS患儿血清miR-34a高表达,Ang-1则低表达,且两者均是NRDS患儿死亡的危险因素,对NRDS患儿不良预后具有较好的预测价值。

Objective To investigate the relationship between serum microrna-34a(miR-34a)and angiopoietin-1(Ang-1)levels and the prognosis of neonatal respiratory distress syndrome(NRDS).Methods 178 children with NRDS admitted to Handan central hospital obstetrics and gynecology department hospital from January 2020 to December 2022 were selected as the study objects and included in the NRDS group,and 178 healthy newborns were selected as the control group.The serum levels of miR-34a and Ang-1 were compared between the two groups.With the diagnosis of NRDS as the starting point,the newborns were divided into survival group(n=140)and death group(n=38)according to the prognosis.Logistic regression model was used to analyze the related factors affecting the death of NRDS children.The predictive value of serum miR-34a and Ang-1 on the death of children with NRDS was analyzed by receiver operating characteristic curve(ROC).Results The expression level of serum miR-34a in NRDS group was higher than that in control group,but the level of Ang-1 was lower than that in control group,and the difference was statistically significant(P<0.05).The proportion of cesarean section,the proportion of dangerous placenta previa,white blood cell count,C-reactive protein(CRP),interleukin-6(IL-6),troponin-ⅰ,SNAPPEⅡscores and serum miR-34a expression level in the death group were higher than those in the survival group,but the level of Ang-1 was lower than those in the survival group,with statistical significance(P<0.05).Logistic regression analysis model showed that high serum miR-34a expression level,SNAPPEⅡscore,IL-6 level and low Ang-1 level were all risk factors for death in children with NRDS(P<0.05).ROC curve analysis showed that the AUC(95%CI)of serum miR-34a and Ang-1 to predict the death of NRDS children were 0.770(0.702~0.830)and 0.808(0.742~0.863),respectively.LogP model fitting combined diagnosis was adopted.The results showed that the combined diagnosis AUC(95%CI)was 0.887(0.815~0.939),which was higher than that of any single test(P<0.05).Conclusion Serum miR-34a expression was high in children with NRDS,while Ang-1 expression was low,and both of them were risk factors for death in children with NRDS,and had good predictive value for poor prognosis in children with NRDS.