慢性阻塞性肺疾病患者血清微小RNA-218、微小RNA-29b水平变化及对急性加重期的预测价值

Changes in serum miR-218 and miR-29b levels in patients with chronic obstructive pulmonary disease and their predictive value for acute exacerbation in patients

目的探究慢性阻塞性肺疾病(COPD)患者血清微小RNA-218(miR-218)、微小RNA-29b(miR-29b)水平的变化及其对COPD急性加重期的预测价值。方法选取2022年5月至2023年5月于湖北民族大学附属民大医院治疗的116例COPD患者为病例组,根据入院后28 d的病情分为加重组(68例)和稳定组(48例);另选取同期116例体检健康者为对照组。采用荧光定量PCR法测定血清中miR-218、miR-29b的水平,采用多因素logistic回归分析COPD急性加重期的影响因素,采用受试者操作特征(ROC)曲线分析血清miR-218、miR-29b水平对COPD急性加重期的预测价值。结果病例组血清miR-218、miR-29b水平明显低于对照组(P<0.05)。加重组患者的年龄、性别、体重指数以及合并高血压、糖尿病、高脂血症的比例与稳定组比较差异无统计学意义(P>0.05),病程及吸烟史比例高于稳定组(P<0.05),miR-218、miR-29b水平均低于稳定组(P<0.05)。多因素logistic回归分析显示,miR-218、miR-29b为COPD急性加重期的独立保护因素(P<0.05),病程、吸烟史为COPD急性加重期的独立危险因素(P<0.05)。ROC曲线分析显示,血清miR-218、miR-29b水平预测COPD急性加重期的曲线下面积(AUC)分别为0.797、0.775,二者联合预测的AUC为0.876,优于单独预测(Z二者联合-miR-218=2.162、Z二者联合-miR-29b=2.296,P=0.031、0.022),二者联合预测的敏感度为95.59%,特异性为64.58%。结论COPD患者血清miR-218、miR-29b水平明显下调,且为COPD急性加重期的独立保护因素,二者联合应用对COPD急性加重期具有更高的预测价值。

Objective To investigate the alterations in serum levels of microRNA-218(miR-218)and microRNA-29b(miR-29b)in patients diagnosed with chronic obstructive pulmonary disease(COPD),as well as their predictive significance for acute exacerbations.Method A total of 116 COPD patients who were treated in Minda Hospital of Hubei Minzu University from May 2022 to May 2023 were regarded as the diseased group.They were categorized into two groups based on their condition 28 days after admission:the exacerbation group(68 cases)and the stable group(48 cases).Another 116 healthy individuals who underwent physical examinations were regarded as the control group.Fluorescence quantitative PCR method was used to determine the levels of miR-218 and miR-29b in serum.Multivariate logistic regression analysis of the influencing factors of COPD patients developing into acute exacerbation phase.ROC curve was applied to analyze the predictive value of serum miR-218 and miR-29b levels for the development of acute exacerbation in COPD patients.Result Compared with the control group,the serum miR-218 and miR-29b levels in the diseased group were obviously reduced(P<0.05).Compared with the stable group,there was no obvious difference in age,sex,BMI,and the number of cases of hypertension,diabetes,and hyperlipidemia in the exacerbation group(P>0.05).The number of cases of disease duration and smoking history increased obviously(P<0.05),and the levels of miR-218 and miR-29b decreased obviously(P<0.05).MiR-218 and miR-29b were independent protective factors for the development of acute exacerbation in patients(P<0.05),while disease course and smoking history were independent risk factors for the development of acute exacerbation in patients(P<0.05).The area under the curve(AUC)predicted by serum miR-218 and miR-29b levels for COPD patients to develop into acute exacerbation was 0.797 and 0.775,respectively,the combined AUC predicted by the two was 0.876.The combined prediction of the two was superior to their individual predictions(Zcombination-miR-218=2.162,Zcombination-miR-29b=2.296,P=0.031,0.022),with a sensitivity of 95.59%and a specificity of 64.58%.Conclusion Serum miR-218 and miR-29b are obviously down-regulated in COPD patients,and they are independent protective factors for acute exacerbation.The combination of the two has higher predictive value for COPD patients developing into acute exacerbation.