脓毒症并发急性肾损伤患者血清LncRNA GAS5、miR-23a-3p表达及其临床意义

Expression and clinical significance of serum LncRNA GAS5 and miR-23a-3p in patients with sepsis complicated with acute kidney injury

目的探讨脓毒症并发急性肾损伤(AKI)患者血清长链非编码核糖核酸生长阻滞特异性转录本5(LncRNAGAS5)、微小核糖核酸(miR)-23a-3p的表达及其临床意义。方法前瞻性选择2020年5月至2023年2月浙江中医药大学滨江学院附属富阳第一医院急诊医学科收治的206例脓毒症患者,根据是否并发AKI将患者分为AKI组(95例)和对照组(111例)。检测血清LncRNA GAS5、miR-23a-3p表达,采用logistic回归分析法筛选脓毒症患者并发AKI的影响因素,采用受试者工作特征(ROC)曲线分析LncRNAGAS5、miR-23a-3p预测毒症并发AKI的价值。结果AKI组机械通气、输血治疗比例、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、WBC,血清C-反应蛋白(CRP)、降钙素原(PCT)、尿素氮(BUN)、肌酐(Scr),血乳酸水平高于对照组(均P<0.05),入院时MAP、尿量、估算肾小球滤过率(eCFR)低于对照组(均P<0.05)。AKI组血清LncRNAGAS5表达(5.12±1.69vs2.30±0.42)高于对照组(P<0.05),miR-23a-3p表达(1.05±0.13vs3.04±0.67)低于对照组(P<0.05)。Logistic回归分析显示,高APACHEIⅡI评分、高SOFA评分、高表达LncRNAGAS5是脓毒症患者并发AKI的危险因素(均P<0.05),高eGFR、高表达miR-23a-3p是保护因素(均P<0.05)。LncRNAGAS5、miR-23a-3p预测脓毒症患者并发AKI的曲线下面积(AUC)为0.808、0.759,联合预测AUC为0.882,高于单独指标预测结论脓毒症并发AKI患者血清LncRNAGAS5表达上调,miR-23a-3p表达下调,联合检测LncRNA GAS5、miR-23a-3p对于预测脓毒症患者AKI发生风险具有较高价值。

Objective To investigate the expression of long non-coding RNA growth retard-specific transcript 5(LncRNA GAS5)and micrornas(miR)23a-3p in patients with sepsis complicated with acute kidney injury(AKI)and their clinical significance.Methods A total of 206 patients with sepsis admitted to the Department of Emergency Medicine,Fuyang First Hospital Affiliated to Binjiang College of Zhejiang University of Traditional Chinese Medicine from May 2020 to February 2023 were prospectively selected and divided into AKI group(95 cases)and control group(111 cases)according to whether they had concurrent AKI.Serum LncRNA GAS5 and miR-23a-3p expressions were detected.logistic regression analysis was used to screen the influencing factors of patients with sepsis complicated with AKI,and receiver operating characteristic(ROC)curve was used to analyze the value of LncRNA CAS5 and miR-23a-3p in predicting sepsis complicated with AKI.Results Mechanical ventilation,blood transfusion treatment ratio,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment SOFA)score,white blood cell count(WBC),serum C-reactive protein(CRP),procalcitonin(PCT),blood urea nitrogen(BUN),Scr,blood lactic acid level of the AKI group were higher than those of the control group(all P<0.05);mean arterial pressure(MAP),urine volume,estimate glomerular filtration rate(eGFR)at admission were lower than those of the control group(all P<0.05).Serum LncRNA GAS5 expression(5.12±1.69 vs 2.30±0.42)in AKI group was higher than that in the control group(P<0.05),and miR-23a-3p expression(1.05±0.13 vs 3.04±0.67)was lower than that in the control group(P<0.05).Logistic regression analysis showed that high APACHE Ⅱ score,high SOFA score and high expression of LncRNA GAS5 were risk factors for AKI in sepsis patients(all P<0.05).High eCFR and high expression of miR-23a-3p were protective factors(all P<0.05).The area under the curve(AUC)predicted by LncRNA GAS5 and miR-23a-3p for patients with sepsis complicated with AKI was 0.808 and 0.759,and the AUC of combined prediction was 0.882,which was higher than that predicted by single indicator.Conclusions The expression of LncRNA GAS5 is up-regulated and the expression of miR-23a-3p is down-regulated in serum of patients with sepsis complicated with AKI.The combined detection of LncRNA CAS5 and miR-23a-3p is of high value in predicting the risk of AKI in patients with sepsis.