肝硬化合并感染患者的临床特点及血清miRNA-122与预后关系

Clinical characteristics and relationship between serum miRNA⁃122 and prognosis in patients with cirrhosis combined with infection

目的探讨肝硬化合并感染患者的临床特点及血清miRNA-122与预后的关系。方法回顾性分析广州市红十字会医院急诊医学科2019年1月-2022年12月收治的160例肝硬化患者的临床资料,其中80例肝硬化合并感染患者作为感染组,80例肝硬化未合并感染患者作为非感染组。根据患者首次住院后观察28 d结果,将感染组患者分为好转组59例和恶化组21例。分析感染组感染部位和细菌培养标本来源情况、细菌种类及药敏情况;对影响肝硬化合并感染因素进行单因素分析,分析感染组患者血清miRNA-122与Child肝功能分级、终末期肝病模型(MELD)评分的相关性;比较好转组与恶化组血清miRNA-122水平,并分析miRNA-122对肝硬化合并感染患者预后预测的价值。结果80例肝硬化合并感染患者以自发性腹膜炎(37.50%)和肺部感染(27.50%)为主,病原菌以革兰阴性菌(69.42%)为主;感染组肝硬化失代偿期占比、嗜酒史占比、Child肝功能分级B级或C级占比、血清miRNA-122水平高于非感染组,差异均有统计学意义(χ^(2)/t=7.281、21.781、5.980、5.578,P均<0.05),血清白蛋白水平低于非感染组,差异有统计学意义(t=4.193,P<0.05)。Pearson相关性分析结果显示,肝硬化合并感染患者血清miRNA-122与Child肝功能分级、MELD评分均成正相关(r=0.375、0.291,P=0.002、0.021)。好转组血清miRNA-122低于恶化组,差异有统计学意义(t=12.746,P<0.05)。血清miRNA-122对肝硬化合并感染患者预后预测价值的曲线下面积(AUC)为0.823,敏感度为75.00%,特异度为75.00%。结论肝硬化合并感染患者以自发性腹膜炎和肺部感染常见,病原菌以革兰阴性菌为主,血清miRNA-122对肝硬化合并感染患者预后有一定预测价值。

Objective To investigate the clinical characteristics and the relationship between serum miRNA⁃122 and prognosis in patients with cirrhosis complicated with infection.Methods Clinical data of 160 patients with cirrhosis admitted to the Guangzhou Red Cross Hospital Emergency Medicine Department from January 2019 to December 2022 were retrospectively analyzed.Of which,80 patients with cirrhosis combined with infection were taken as the infected group and 80 patients with cirrhosis without infection were taken as the non⁃infected group.According to the observation results 28 days after the first hospitalization,the infected patients were divided into 59 cases of improvement group and 21 cases of deterioration group.The infection site,the source of bacterial culture specimens,bacterial species and drug susceptibility of the infected group were analyzed.The correlation between serum miRNA⁃122 and Child liver function grade and model for end⁃stage liver disease(MELD)score in patients with cirrhosis combined with infection were analyzed.Univariate analysis were conducted to compare the serum miRNA⁃122 levels in the improved group and the deterioration group,and analyze the prognostic value of miRNA⁃122 in patients with cirrhosis and infection.Results The 80 patients with cirrhosis complicated by infection were mainly spontaneous peritonitis(37.50%)and pulmonary infection(27.50%),and the pathogens were mainly Gram⁃negative bacteria(69.42%).The proportion of decompensated cirrhosis,alcoholism history,Child's liver function grade B or C,and serum miRNA⁃122 level in the infection group were significantly higher than those in the non⁃infection group,the differences were statistically significant(χ^(2)/t=7.281,21.781,5.980,5.578;all P<0.05).The serum albumin level was significantly lower than that in the non⁃infection group,the difference was statistically significant(t=4.193,P<0.05).Pearson correlation analysis showed that serum miRNA⁃122 in patients with cirrhosis complicated with infection was positively correlated with Child's liver function grade and MELD score(r=0.375,0.291,P=0.002,0.021).The serum miRNA⁃122 level in the improvement group was significantly lower than that in the deterioration group,the difference was statistically significant(t=12.746,P<0.05).The area under the curve(AUC)of serum miRNA⁃122 for predicting the prognosis of patients with cirrhosis and infection was 0.823,with a sensitivity of 75.00%and a specificity of 75.00%.Conclusions Spontaneous peritonitis and pulmonary infection were common in patients with cirrhosis combined with infection,and the pathogenic bacteria were mainly Gram⁃negative bacteria.Serum miRNA⁃122 had certain predictive value in the prognosis of patients with cirrhosis combined with infection.