外周血游离线粒体DNA、miR-146a表达对评估脓毒症患者近期预后的价值

Predictive efficacy of free mitochondrial DNA and miR⁃146a expression in peripheral blood in assessing short term prognosis of sepsis

目的分析外周血游离线粒体脱氧核糖核酸(DNA)、微小核糖核酸(miRNA,miR)-146a表达对脓毒症患者近期预后不良评估的价值。方法选取医院2021年3月至2023年2月收治的145例脓毒症患者,检测外周血游离线粒体DNA、miR-146a表达。统计28 d预后不良发生率,据此分为预后不良组和预后良好组。比较两组一般资料及外周血游离线粒体DNA、miR-146a表达;logistic回归分析患者预后不良的影响因素;受试者工作特征(ROC)曲线分析二者对脓毒症近期预后的预测效能。结果145例患者中有24例入院48 h内死亡、3例转院、1例主动放弃治疗,最终纳入研究的139例患者近期预后不良发生率为28.78%;合并糖尿病(OR=1.765,95%CI:1.181~2.637)、急性生理学与慢性健康状况(APACHEⅡ)评分(OR=1.972,95%CI:1.317~2.953)、外周血游离线粒体DNA(OR=2.416,95%CI:1.524~3.829)、miR-146a表达(OR=2.462,95%CI:1.431~4.237)均是脓毒症患者近期预后不良的危险因素(P<0.05);外周血游离线粒体DNA、miR-146a表达预测近期预后不良的灵敏度、特异度、曲线下面积(AUC)均高于APACHEⅡ评分(P<0.05),且外周血游离线粒体DNA、miR-146a表达联合预测近期预后不良的灵敏度、AUC均高于二者单独预测(P<0.05)。结论外周血游离线粒体DNA、miR-146a表达升高均与脓毒症近期预后不良有关,二者评估近期预后不良的效能优于APACHEⅡ评分,且二者联合的预测效能更佳。

Objective To explore the value of free mitochondrial deoxyribonucleic acid(DNA)and micro ribonucleic acid(miRNA,miR)⁃146a expression in peripheral blood in assessing short⁃term prognosis of sepsis.Methods Totally 145 patients with sepsis admitted to the hospital from March 2021 to February 2023 were selected to detect the free mitochondrial DNA and miR⁃146a expression in peripheral blood.The incidence of poor prognosis after 28 days was counted,and the patients were then divided into poor prognosis group and good prognosis group.The general data and the free mitochondrial DNA and miR⁃146a expression in peripheral blood of the two groups were compared.Logistic regression analysis was used to explore the influencing factors of poor prognosis in patients.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of free mitochondrial DNA and miR⁃146a expressionin assessing the short⁃term prognosis of sepsis.Results The incidence of poor short⁃term prognosis in the 139 patients who completed the study was 28.78%.Concurrent diabetes(OR=1.765,95%CI:1.181~2.637),acutephysiology and chronic health evaluation(APACHEⅡ)score(OR=1.972,95%CI:1.317~2.953),free mitochondrial DNA in peripheral blood(OR=2.416,95%CI:1.524~3.829),and miR⁃146a expres⁃sion(OR=2.462,95%CI:1.431~4.237)were risk factors for poor short⁃term prognosis of patients with sepsis(P<0.05).The sensitivity,specificity and area under curve(AUC)of free mitochondrial DNA and miR⁃146a expression in peripheral blood to predict poor short⁃term prognosis were higher than those of APACHEⅡscore(P<0.05),and the sensitivity and AUC of free mitochondrial DNA and miR⁃146a expressions in peripheral blood to predict poor short⁃term prognosis were higher than those of both alone(P<0.05).Conclusions Free mitochondrial DNA and miR⁃146a expression in peripheral blood are related to poor short⁃term prognosis of sepsis.The efficacy of both of them in assessing poor short⁃term prognosis of sepsis is better than that of APACHEⅡscore,and their combined prediction efficacy is even better.