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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2018, Vol. 11 ›› Issue (05) : 310 -315. doi: 10.3877/cma.j.issn.1674-6880.2018.05.006

所属专题： 文献；

论著

微小RNA-142-3p在脓毒症患者血清中的表达及其临床意义
李洁1, 孙敏1, 乐健伟1, 陈红1, 朱建华1,†()   
  1. 1. 315010　浙江宁波，宁波市第一医院重症医学科
  • 收稿日期:2018-03-14 出版日期:2018-10-01
  • 通信作者: 朱建华
  • 基金资助:
    浙江省医药卫生科技计划项目(2017KY585)

Expression of microRNA-142-3p in serum of septic patients and its clinical significance

Jie Li1, Min Sun1, Jianwei Le1, Hong Chen1, Jianhua Zhu1,†()   

  1. 1. Department of Intensive Care Unit, Ningbo First Hospital, Ningbo 315010, China
  • Received:2018-03-14 Published:2018-10-01
  • Corresponding author: Jianhua Zhu
  • About author:
    Corresponding author: Zhu Jianhua, Email:
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引用本文：

李洁, 孙敏, 乐健伟, 陈红, 朱建华. 微小RNA-142-3p在脓毒症患者血清中的表达及其临床意义[J]. 中华危重症医学杂志(电子版), 2018, 11(05): 310-315.

Jie Li, Min Sun, Jianwei Le, Hong Chen, Jianhua Zhu. Expression of microRNA-142-3p in serum of septic patients and its clinical significance[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(05): 310-315.

目的

通过观察脓毒症患者血清中微小RNA-142-3p（miR-142-3p）的表达，探讨其与脓毒症的关系。

方法

选取41例脓毒症患者作为研究对象，同期住院的非脓毒症患者20例作为对照组。采用实时荧光定量PCR检测血清中miR-142-3p的表达，酶联免疫吸附剂测定（ELISA）检测白细胞介素6（IL-6）和IL-10的表达。采用Spearman相关分析miR-142-3p与患者临床特点和实验室指标的相关性，受试者工作特征（ROC）曲线评价miR-142-3p、IL-6、IL-10、C反应蛋白（CRP）、前降钙素原（PCT）、白细胞计数和乳酸表达水平对脓毒症的预测价值。

结果

脓毒症组患者的白细胞计数[（14.4 ± 7.8）× 109/L vs.（8.4 ± 2.1）× 109/L，t = 4.571，P < 0.001]、CRP [（127 ± 80）mg/L vs.（80 ± 45）mg/L，t = 2.436，P= 0.018]、乳酸[（2.3 ± 1.8）mmol/L vs.（1.5 ± 0.6）mmol/L，t = 2.421，P = 0.019]、PCT [5.70（1.49，26.37）μg/L vs. 0.25（0.10，0.63）μg/L，Z= 75.500，P < 0.001]、IL-6 [342.33（64.98，2 618.44）ng/L vs. 14.95（3.21，54.51）ng/L，Z = 84.000，P < 0.001]、IL-10 [23.16（6.19，85.56）ng/L vs. 2.75（1.39，5.36）ng/L，Z = 198.500，P = 0.001]和miR-142-3p [95.74（23.19，278.23）vs. 25.64（18.59，56.05），Z = 222.000，P = 0.004]均显著高于对照组。miR-142-3p与乳酸、IL-6、PCT均呈正相关（r = 0.427、0.340、0.309，P = 0.005、0.030、0.049）。根据脓毒症患者28 d生存情况分为存活组（29例）和死亡组（12例）。存活组的急性病生理学与长期健康评价（APACHE）Ⅱ评分[（14 ± 6）分vs.（25 ± 6）分]、序贯性器官衰竭估计（SOFA）评分[（6.0 ± 2.8）分vs.（10.7 ± 3.5）分]和乳酸[（1.6 ± 1.0）mmol/L vs.（3.8 ± 2.6）mmol/L]水平均显著低于死亡组（t = 5.406、4.482、2.835，P均< 0.05）。ROC曲线分析结果显示，miR-142-3p [曲线下面积（AUC）= 0.729，95%CI（0.602，0.856），P = 0.004]、IL-6 [AUC = 0.898，95%CI（0.820，0.975），P < 0.001]、CRP [AUC = 0.698，95%CI（0.566，0.831），P = 0.013]、PCT [AUC = 0.908，95%CI（0.835，0.981），P < 0.001]、IL-10 [AUC = 0.758，95%CI（（0.631，0.885），P = 0.001]和白细胞计数[AUC = 0.776，95%CI（0.659，0.893），P = 0.001]对脓毒症均有预测价值。

结论

脓毒症患者血清中miR-142-3p的表达升高，且与乳酸、IL-6、PCT呈正相关，其在脓毒症发生发展中可能发挥着重要作用。

关键词: 脓毒症, 微小RNA-142-3p, 血清
Objective

To observe the expression of serum microRNA-142-3p (miR-142-3p) in septic patients and to explore its relationship with sepsis.

Methods

Forty-one patients with sepsis were selected as study subjects, and 20 non-septic patients hospitalized in the same period as the control group. The expression of serum miR-142-3p was detected by real-time quantitative PCR, and levels of interleukin-6 (IL-6) and IL-10 were detected by enzyme-linked immunosorbent assay (ELISA). The relationship between miR-142-3p and septic patients' clinical characteristics and laboratory indexes was analyzed by Spearman correlation analysis. In the same time, the predictive value of miR-142-3p, IL-6, IL-10, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count and lactic acid on sepsis was evaluated by the receiver operating characteristic (ROC) curve.

Results

The white blood cell count [(14.4 ± 7.8) × 109/L vs. (8.4 ± 2.1) × 109/L, t = 4.571, P < 0.001], CRP [(127 ± 80) mg/L vs. (80 ± 45) mg/L, t = 2.436, P = 0.018], lactic acid [(2.3 ± 1.8) mmol/L vs. (1.5 ± 0.6) mmol/L, t = 2.421, P = 0.019], PCT [5.70 (1.49, 26.37) μg/L vs. 0.25 (0.10, 0.63) μg/L, Z = 75.500, P < 0.001], IL-6 [342.33 (64.98, 2 618.44) ng/L vs. 14.95 (3.21, 54.51) ng/L, Z = 84.000, P < 0.001], IL-10 [23.16 (6.19, 85.56) ng/L vs. 2.75 (1.39, 5.36) ng/L, Z = 198.500, P = 0.001] and miR-142-3p [95.74 (23.19, 278.23) vs. 25.64 (18.59, 56.05), Z = 222.000, P = 0.004] were significantly higher in the sepsis group than in control group. MiR-142-3p was positively correlated with lactic acid, IL-6 and PCT (r = 0.427, 0.340, 0.309; P = 0.005, 0.030, 0.049). Patients with sepsis were divided into the survival group (29 cases) and death group (12 cases) according to their survival conditions on 28 days. The scores of acute physiology and chronic health evaluation (APACHE) Ⅱ [(14 ± 6) vs. (25 ± 6)] and sequential organ failure assessment (SOFA) [(6.0 ± 2.8) vs. (10.7 ± 3.5)], and lactic acid expression [(1.6 ± 1.0) mmol/L vs. (3.8 ± 2.6) mmol/L] in the survival group were significantly lower than those in the death group (t = 5.406, 4.482, 2.835; all P < 0.05). ROC curve analysis showed that miR-142-3p [area under the curve (AUC) = 0.729, 95%CI (0.602, 0.856), P = 0.004], IL-6 [AUC = 0.898, 95%CI (0.820, 0.975), P < 0.001], CRP [AUC = 0.698, 95%CI (0.566, 0.831), P = 0.013], PCT [AUC = 0.908, 95%CI (0.835, 0.981), P < 0.001], IL-10 [AUC = 0.758, 95%CI (0.631, 0.885), P = 0.001)] and white blood cell count [AUC = 0.776, 95%CI (0.659, 0.893), P = 0.001)] have predictive value for sepsis.

Conclusion

The expression of serum miR-142-3p in septic patients increases, and it is positively related with lactic acid, IL-6 and PCT, which may play an important role in the development of sepsis.

Key words: Sepsis, MicroRNA-142-3p, Serum
表1 脓毒症组和对照组患者一般资料及实验室指标比较（ ± s）
组别 例数 年龄（岁） 性别比（例，男/女） APACHEⅡ评分（分） SOFA评分（分） 白细胞计数(× 109/L) CRP(mg/L) 乳酸(mmol/L)
对照组 20 60 ± 17 12/8 15 ± 3 6.1 ± 1.5 8.4 ± 2.1 80 ± 45 1.5 ± 0.6
脓毒症组 41 59 ± 18 19/22 17 ± 8 7.4 ± 3.6 14.4 ± 7.8 127 ± 80 2.3 ± 1.8
t/χ2/Z值 ? 0.286 1.003 1.148 1.952 4.571 2.436 2.421
P值 ? 0.776 0.316 0.256 0.056 < 0.001 0.018 0.019
组别 例数 PCT [μg/L,M(P25,P75)] IL-6 [ng/L,M(P25,P75)] IL-10[ng/L,M(P25,P75)] miR-142-3p[M(P25,P75)]
对照组 20 0.25(0.10,0.63) 14.95(3.21,54.51) 2.75(1.39,5.36) 25.64(18.59,56.05)
脓毒症组 41 5.70(1.49,26.37) 342.33(64.98,2 618.44) 23.16(6.19,85.56) 95.74(23.19,278.23)
t/χ2/Z值 ? 75.500 84.000 198.500 222.000
P值 ? < 0.001 < 0.001 0.001 0.004
表2 存活组与死亡组脓毒症患者一般资料及实验室指标比较（ ± s）
组别 例数 年龄（岁） 性别比（例，男/女） APACHEⅡ评分（分） SOFA评分（分） 白细胞计数(× 109/L) CRP(mg/L) 乳酸(mmol/L)
存活组 29 56 ± 20 11/18 14 ± 6 6.0 ± 2.8 15 ± 8 127 ± 67 1.6 ± 1.0
死亡组 12 67 ± 12 8/4 25 ± 6 10.7 ± 3.5 12 ± 8 127 ± 109 3.8 ± 2.6
t/χ2/Z值 ? 1.910 1.781 5.406 4.482 1.232 0.015 2.835
P值 ? 0.064 0.182 < 0.001 < 0.001 0.225 0.998 0.015
组别 例数 PCT [μg/L,M(P25,P75)] IL-6 [ng/L,M(P25,P75)] IL-10[ng/L,M(P25,P75)] miR-142-3p[M(P25,P75)]
存活组 29 5.60(0.70,25.26) 342.33(92.29,2 049.54) 18.95(5.48,77.25) 108.13(27.91,351.32)
死亡组 12 9.78(2.72,29.93) 607.15(53.48,4 333.21) 36.52(5.98,281.55) 83.40(17.20,268.54)
t/χ2/Z值 ? 206.500 192.500 204.500 162.000
P值 ? 0.352 0.596 0.382 0.731
表3 miR-142-3p、IL-6、CRP、PCT、IL-10、白细胞计数和乳酸表达水平对脓毒症预测价值的ROC曲线分析
指标 A,C 95%CI 标准误 敏感度(%) 特异度(%) P值
miR-142-3p 0.729 0.602 ~ 0.856 0.065 68.3 70.0 0.004
IL-6(ng/L) 0.898 0.820 ~ 0.975 0.039 78.0 85.0 < 0.001
CRP(mg/L) 0.698 0.566 ~ 0.831 0.068 78.0 45.0 0.013
PCT(μg/L) 0.908 0.835 ~ 0.981 0.037 82.9 95.0 < 0.001
IL-10(ng/L) 0.758 0.631 ~ 0.885 0.065 78.0 75.0 0.001
白细胞计数(× 109/L) 0.776 0.659 ~ 0.893 0.060 73.2 70.0 0.001
乳酸(mmol/L) 0.598 0.454 ~ 0.741 0.073 51.2 60.0 0.219
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