血清miR-497、miR-5787水平变化对重症脑卒中并发不同严重程度肺部感染的预测及与炎症反应的相关性

Changes in serum miR-497 and miR-5787 levels to predict the severity of pulmonary infections in severe stroke patients and their correlation with inflammatory response

目的探讨血清miR-497、miR-5787水平变化对重症脑卒中并发不同严重程度肺部感染的预测及与炎症反应的相关性。方法回顾性研究河北省邢台市第三医院收治的重症脑卒中患者202例,根据是否发生肺部感染和病情严重程度,将患者分成非感染组、轻中度感染组和重症感染组,检测不同组别患者血清miR-497和miR-5787,并收集炎性因子,Pearson法分析血清miR-497和miR-5787与炎性因子的相关性,单因素和多因素Logistic回归分析确定肺部感染不同严重程度的危险因素,ROC曲线评估血清miR-497和miR-5787对肺部感染不同严重程度预测价值。结果非感染组患者血清C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin 6,IL-6)和肿瘤坏死因子α(tumor necrosis factor-alpha,TNF-α)低于轻中度感染组和重症感染组,轻中度感染组CRP、IL-6和TNF-α低于重症感染组(P<0.05)。非感染组血清miR-497和miR-5787低于轻中度感染组和重症感染组,轻中度感染组血清miR-497和miR-5787低于重症感染组。血清miR-497与血清CRP、IL-6和TNF-α呈正相关(r=0.756、0.595、0.718,P<0.001);血清miR-5787与血清CRP、IL-6和TNF-α呈正相关(r=0.929、0.827、0.878,P<0.001)。Logistic回归分析,miR-497(OR=1.824,95%CI:1.473~2.258)和miR-5787(OR=2.034,95%CI:1.234~3.353)是重症脑卒中发生肺部感染的影响因素(P<0.05)。ROC结果显示,miR-497诊断的临界值为3.55,其对应的敏感度为69.77%,特异度为71.07%,AUC为0.801(95%CI:0.750~0.852);miR-5787诊断的临界值为10.27,其对应的敏感度为74.42%,特异度为69.81%,AUC为0.760(95%CI:0.707~0.812);回归分析敏感度为86.05%,特异度为83.02%,AUC为0.869(95%CI:0.831~0.907)。结论血清miR-497和miR-5787在重症脑卒中患者中异常高表达,且与肺部感染严重程度呈现正相关,并可应用于预测重症脑卒中肺部感染,值得临床进一步研究并推广。

Objective To explore the prediction of the severity of pulmonary infections in severe stroke patients by changes in serum levels of miR-497 and miR-5787 and their correlation with inflammatory response.Methods A retrospective study was conducted on 202 patients with severe stroke treated in the Third Hospital of Xingtai City.The patients were classified into three groups based on the occurrence and severity of pulmonary infection:non-infection group,mild to moderate infection group,and severe infection group.Serum levels of miR-497 and miR-5787 were evaluated in patients from these groups,and inflammatory factors were collected.The correlation between serum miR-497 and miR-5787 levels and inflammatory factors was analyzed using the Pearson method.Univariate and multivariate Logistic regression analyses were performed to identify the risk factors associated with different severities of pulmonary infection.Additionally,the predictive value of serum miR-497 and miR-5787 for different severities of pulmonary infection was assessed using receiver operating characteristic(ROC)curves.Results The serum C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)levels in the non-infection group were lower than those in the mild to moderate infection group and severe infection group,which were lower in the mild to moderate infection group than in the severe infection group(P<0.05).The serum miR-497 and miR-5787 levels in the non-infection group were lower than those in the mild to moderate infection group and severe infection group,which were lower in the mild to moderate infection group than in the severe infection group.Serum miR-497 was positively correlated with serum CRP,IL-6,and TNF-α(r=0.756,0.595,0.718,P<0.001),and serum miR-5787 was positively correlated with serum CRP,IL-6,and TNF-α(r=0.929,0.827,0.878,P<0.001).Logistic regression analysis showed that miR-497(OR=1.824,95%CI:1.473-2.258)and miR-5787(OR=2.034,95%CI:1.234-3.353)were influencing factors for pulmonary infection in patients with severe stroke(P<0.05).The ROC results showed that the critical value for miR-497 diagnosis was 3.55,with a corresponding sensitivity of 69.77%,specificity of 71.07%,and the area under the ROC curve(AUC)of 0.801(95%CI:0.750-0.852).The critical value for miR-5787 diagnosis was 10.27,with a corresponding sensitivity of 74.42%,specificity of 69.81%,and AUC of 0.760(95%CI:0.707-0.812).The sensitivity of regression analysis was 86.05%,specificity was 83.02%,and AUC was 0.869(95%CI:0.831-0.907).Conclusion Serum levels of miR-497 and miR-5787 are found to be significantly upregulated in patients with severe stroke,which have a positive correlation with the severity of pulmonary infection.They can be used to predict pulmonary infection in severe stroke patients and are worthy of further clinical research and promotion.