摘要
目的:探讨急性胰腺炎(AP)患者血清微小RNA-551-5p(miR-551-5p)、微小RNA-126a-5p(miR-126a-5p)表达水平与AP严重程度的相关性。方法:收集127例AP患者的临床资料,根据病情严重程度分为轻症AP(MAP组)63例和重症AP(SAP组)64例;另选取健康体检者60例为对照组。采用实时定量PCR(qRT-PCR)检测3组血清miR-551-5p和miR-126a-5p水平,采用酶联免疫吸附法(ELISA)检测血清白介素6(IL-6)、白介素18(IL-18)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、淀粉酶(AMS)及脂肪酶(LPS)水平;利用Pearson法分析血清miR-551-5p及miR-126a-5p水平与患者Ranson评分、急性生理与慢性健康评估(APCHEⅡ)评分、血清生化指标的关系;绘制受试者工作特征(ROC)曲线,评估血清miR-551-5p及miR-126a-5p水平对AP的诊断价值;采用Logistic回归分析评估影响AP的危险因素。结果:与对照组比较,SAP组血清TNF-α、IL-6、IL-18、CRP、AMS、LPS水平、Ranson及APCHEⅡ评分显著升高(均P<0.05),MAP组血清IL-6、IL-18、AMS、LPS水平、Ranson及APCHEⅡ评分显著升高(均P<0.05);与MAP组比较,SAP组血清TNF-α、IL-6、CRP水平、Ranson及APCHEⅡ评分显著升高(均P<0.05)。Pearson相关性分析显示,血清miR-551-5p与TNF-α、IL-6、AMS、LPS水平、Ranson及APCHEⅡ评分呈正相关(r值依次为0.755,0.684,0.531,0.519,0.712,0.679,均P<0.05);血清miR-126a-5p与IL-6、IL-18、AMS水平及Ranson评分呈正相关(r值依次为0.711,0.678,0.628,0.701,均P<0.05);血清miR-551-5p、miR-126a-5p诊断SAP的ROC曲线下面积(AUC)分别为0.809、0.800,截断值分别为2.01、1.54,敏感度分别为73.1%、85.3%,特异性分别为82.8%、72.4%;二者联合诊断的AUC为0.965,敏感度为96.5%,特异性为82.4%;多因素Logistic分析结果显示高水平血清AMS、LPS、miR-551-5p、miR-126a-5p是AP的危险因素。结论:血清高水平miR-551-5p及miR-126a-5p可能反映AP患者病情严重程度,是评估SAP患者预后的潜在指标。
Objective:To detect the expression of serum microRNA-551-5 p(miR-551-5 p)and microRNA-126 a-5 p(miR-126 a-5 p)in patients with acute pancreatitis(AP),and to explore the correlation between their expression levels and the severity of AP.Methods:The clinical data of 127 patients with AP were collected,and the patients were divided into 63 cases of mild AP(MAP group)and 64 cases of severe AP(SAP group)according to the severity of the disease.The 60 healthy subjects were selected as the control group.The levels of serum miR-551-5 p and miR-126 a-5 p in each group were detected by real-time quantitative polymerase chain reaction(qRT-PCR),and the contents of serum interleukin 6(IL-6),IL-18,tumor necrosis factorα(TNF-α),C-reactive protein(CRP),amylase(AMS),and lipase(LPS)were determined by enzyme-linked immunosorbent assay(ELISA).The relationship between miR-551-5 p and miR-126 a-5 p expression levels with the Ranson score,acute physiology and chronic health evaluation II(APCHEⅡ)score,serum biochemical indicators in patients with AP was analyzed by the Pearson method.The diagnostic value of miR-551-5 p and miR-126 a-5 p in AP was evaluated by drawing receiver operating characteristic(ROC)curve.The risk factors of AP were analyzed by Logistic regression.Results:Compared with the control group,the levels of TNF-α,IL-6,IL-18,CRP,AMS,LPS,and Ranson and APCHEⅡscores in the SAP group were significantly increased(all P<0.05);the levels of IL-6,IL-18,AMS,LPS,and scores of Ranson and APCHEⅡin the MAP group were significantly increased(all P<0.05).As compared with the MAP group,the levels of TNF-α,IL-6,and CRP,and Ranson and APCHEⅡscores in the SAP group were significantly increased(all P<0.05).Pearson correlation analysis showed that serum miR-551-5 p was positively correlated with TNF-α,IL-6,AMS,LPS levels,Ranson and APCHEⅡscores(r values were 0.755,0.684,0.531,0.519,0.712,0.679,respectively,all P<0.05);serum miR-126 a-5 p was positively correlated with IL-6,IL-18,AMS levels and Ranson scores(r values were 0.711,0.678,0.628,0.701,all P<0.05).The ROC curve results showed that the areas under the curve(AUC)for miR-551-5 p and miR-126 a-5 p in the diagnosis of SAP was 0.809 and 0.800,the cutoffs were 2.01 and 1.54,the sensitivity was 73.1%and 85.3%,and the specificity was 82.8%and 72.4%respectively.The AUC of the combined diagnosis was 0.965,the sensitivity was 96.5%,and the specificity was 82.4%.The multivariate Logistic analysis showed that high serum AMS,LPS,miR-551-5 p,miR-126 a-5 p levels were risk factors for AP.Conclusion:The high levels of miR-551-5 p and miR-126 a-5 p in serum may reflect the severity of AP patients,which is a potential index to evaluate the prognosis of SAP patients.
作者
李刚
王学莉
LI Gang;WANG Xue-li(Hanzhong 3201st Hospital,Hanzhong 723000,China)
出处
《内科急危重症杂志》
2020年第3期203-206,215,共5页
Journal of Critical Care In Internal Medicine
基金
陕西省汉中市3201医院课题基金资助(No:3201yk201601)
作者简介
通信作者:王学莉,E-mail:xlwang@sina.com
