血清miR-96-5p、miR-486-5p水平与创伤后脓毒症患者机体炎症反应及预后的关系分析

Relationship between serum miR-96-5p,miR-486-5p levels and inflammatory response and prognosis in patients with post-traumatic sepsis

目的 分析血清微小RNA(miR)-96-5p、miR-486-5p水平与创伤后脓毒症患者机体炎症反应及预后的关系。方法 选取2019年3月至2022年10月海南医学院第一附属医院收治的205例创伤患者,根据治疗期间是否进展为脓毒症将患者分为脓毒症组(77例)与非脓毒症组(128例)。采用实时荧光定量聚合酶链反应(PCR)检测两组血清miR-96-5p、miR-486-5p相对表达水平,检测血清炎症细胞因子[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素6(IL-6)]水平,采用Pearson相关性分析脓毒症组血清miR-96-5p、miR-486-5p表达与炎症细胞因子的相关性。进一步分析创伤后脓毒症患者的预后,根据住院期间的存活结局分为存活组与死亡组;采用多因素Logistic回归模型分析创伤后脓毒症患者死亡的影响因素,受试者工作特征(ROC)曲线分析miR-96-5p、miR-486-5p对创伤后脓毒症患者死亡的预测价值。结果 脓毒症组血清miR-96-5p相对表达水平低于非脓毒症组(P<0.05),miR-486-5p相对表达水平高于非脓毒症组(P<0.05)。脓毒症组血清CRP、PCT、IL-6水平高于非脓毒症组(P<0.05)。Pearson相关性分析显示,脓毒症组miR-96-5p相对表达水平与CRP、PCT、IL-6水平呈负相关(P<0.05),miR-486-5p相对表达水平与CRP、PCT、IL-6水平呈正相关(P<0.05)。77例创伤后脓毒症患者生存67例,死亡10例。多因素Logistic回归分析显示,miR-96-5p相对表达水平升高为创伤后脓毒症患者死亡的保护因素(P<0.05),损伤严重度评分(ISS)升高、miR-486-5p相对表达水平升高为创伤后脓毒症患者死亡的危险因素(P<0.05)。ROC曲线结果显示,ISS、miR-96-5p、miR-486-5p三者联合预测创伤后脓毒症患者死亡的曲线下面积为0.860,灵敏度和特异度分别为0.900、0.821,联合检测的预测效能高于单独检测。结论 创伤后脓毒症患者血清miR-96-5p低表达、miR-486-5p高表达,且机体炎症细胞因子水平上升;miR-96-5p、miR-486-5p表达与炎症反应密切相关,二者也是患者死亡的影响因素,对其预后具有一定的预测价值,可为临床早期评估病情及预后提供参考依据。

Objective To analyze the relationship between serum microRNA(miR)-96-5p,miR-486-5p levels and inflammatory response and prognosis in patients with post-traumatic sepsis.Methods A total of 205 trauma patients who were admitted to the First Affiliated Hospital of Hainan Medical University from March 2019 to October 2022 were selected,patients were divided into sepsis group(77 cases)and non-sepsis group(128 cases)according to whether they progressed to sepsis during treatment.The relative expression levels of serum miR-96-5p and miR-486-5p in two groups were detected by real-time fluorescence quantitative PCR,and the levels of serum inflammatory factors[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)]were detected.The correlation between serum miR-96-5p,miR-486-5p expression and inflammatory factors in sepsis group were analyzed by Pearson correlation analysis.The prognosis of patients with post-traumatic sepsis was further analyzed,patients were divided into the survival group and the death group according to the survival outcome during hospitalization.The influencing factors of death in patients with post-traumatic sepsis were analyzed by multivariate Logistic regression model,the value of miR-96-5p and miR-486-5p for predicting death of patients with post-traumatic sepsis were analyzed by receiver operating characteristic(ROC)curve.Results The relative expression level of serum miR-96-5p in sepsis group was lower than that in non-sepsis group(P<0.05),and the relative expression level of miR-486-5p was higher than that in non-sepsis group(P<0.05).The levels of serum CRP,PCT and IL-6 in sepsis group were higher than those in non-sepsis group(P<0.05).Pearson correlation analysis showed that the relative expression level of miR-96-5p in sepsis group was negatively correlated with the levels of CRP,PCT and IL-6(P<0.05),and the relative expression level of miR-486-5p was positively correlated with the levels of CRP,PCT and IL-6(P<0.05).Among 77 patients with post-traumatic sepsis,67 survived and 10 died.Multivariate Logistic regression analysis showed that the increase of the relative expression level of miR-96-5p was a protective factor for death in patients with post-traumatic sepsis(P<0.05),and the increase of injury severity score(ISS)and the relative expression level of miR-486-5p were risk factors for death in patients with post-traumatic sepsis(P<0.05).The ROC curve showed that the area under the curve of the combined detection of ISS,miR-96-5p and miR-486-5p for death in post-traumatic sepsis patients was 0.860,and sensitivity and specificity were 0.900 and 0.821,respectively.The predictive efficacy of combined detection was higher than that of individual detection.Conclusion Serum miR-96-5p is lowly expressed and miR-486-5p is highly expressed in patients with post-traumatic sepsis,and the levels of inflammatory factors increase in the body.The expression of miR-96-5p and miR-486-5p is closely related to the inflammatory response,the two are also influencing factors for the death of patients and have certain predictive value for prognosis,and they could provide a reference basis for early clinical evaluation of the condition and prognosis.