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投稿时间：2022-08-20 网络发布日期：2023-04-20
投稿时间：2022-08-20 网络发布日期：2023-04-20
中文摘要: 目的 探讨微小核糖核酸（miRNA）-125b联合miRNA-133a对脓毒症患者急性呼吸窘迫综合征（ARDS）的早期诊断及预后评估的临床价值。
方法 回顾性分析2019年1月至2021年12月在榆林市第一医院接受治疗的203例脓毒症患者的临床资料,将82例合并ARDS的患者作为观察组,121例未合并ARDS的脓毒症患者作为脓毒症对照组,另选择同期健康体检者90例作为健康对照组。收集各组基本临床资料并测定血清miRNA-125b和miRNA-133a水平;分析两指标对脓毒症患者ARDS的早期诊断价值及脓毒症患者合并ARDS的影响因素。
结果 （1） miRNA-125b和miRNA-133a的相对表达量均呈观察组＞脓毒症对照组＞健康对照组,差异有统计学意义（P＜0.01）。（2） ROC曲线分析显示，miRNA-125b、miRNA-133a以及二者联合对脓毒症合并ARDS的诊断效能参数最佳临界值为2.622（miR-125b）、2.317（miR-133a）,敏感度为84.15%、65.85%、84.15%,特异度为66.12%、83.47%、82.64%,ROC曲线下面积（AUC）为0.818、0.783、0.877;二者联合诊断的AUC优于各自单一诊断（与miRNA-125b比较,Z=2.821,P=0.005;〖JP2〗与miRNA-133a比较,Z=3.521,P＜0.01）。（3） Logistic回归结果显示,APACHE Ⅱ评分≥25分（OR=5.960）、脓毒症休克（OR=3.511）、miRNA-125b相对表达量≥2.622（OR=2.542）和miRNA-133a相对表达量≥2.317（OR=2.781）是脓毒症合并ARDS的独立危险因素（P＜0.01）。
结论 血清miRNA-125b联合miRNA-133a在脓毒症合并ARDS中具有一定的临床价值,可以作为患者早期诊断的重要指标。
中文关键词: 脓毒症 急性呼吸窘迫综合征 微小核糖核酸-125b 微小核糖核酸-133a 诊断效能
Abstract:Objective To explore the clinical value of miRNA-125b combined with miRNA-133a in the early diagnosis and prognosis evaluation of acute respiratory distress syndrome（ARDS） in the patients with sepsis.
Methods A retrospective analysis was conducted in 203 sepsis patients treated at the First Hospital of Yulin between January 2019 and December 2021. The patients complicated with ARDS were selected as observation group（n=82）, the patients without ARDS were selected as sepsis control group（n=121）, and another 90 cases undergoing physical examination were served as healthy control group. The clinical data of each group were collected,and the serum miRNA-125b and miRNA-133a levels were measured to analyze the value of miRNA-125b and miRNA-133a in the early diagnosis of ARDS in patients with sepsis and the influencing factors of them.
Results The relative expression levels of miRNA-125b and miRNA-133a decreased in the order of observation group, sepsis control group and control group, with significant differences in them（P＜0.01）. In diagnosing sepsis complicated with ARDS, the optimal thresheld of miRNA-125b, miRNA-133a were 2.622, 2.317, respectively, the sensitivities of miR-125b, miR-133a and the combination of them were 84.15%, 65.85% and 84.15% and specificities of 66.12%, 83.47% and 82.64%. The area under ROC curve（AUC） were 0.818, 0.783 and 0.877, respectively, and the AUC of combined detection was respectively superior to that of miRNA-125b（Z=2.821, P=0.005） and miRNA-133a（Z=3.521, P＜0.01）.Logistic regression results showed that APACHE Ⅱ score≥25（OR=5.960）, septic shock（OR=3.511） and relative expression levels of miRNA-125b≥2.622（OR=2.542） and miRNA-133a≥2.317（OR=2.781） were the risk factors for sepsis combined with ARDS（P＜0.01）.
Conclusion Combined detection of serum miRNA-125b and miRNA-133a has diagnostic and prognostic value in sepsis patients with ARDS.
文章编号： 中图分类号：R631 R563.8 文献标志码：A
基金项目:
| 作者 | 单位 |
| 徐宁1 | 1. 延安大学第二附属医院 榆林市第一医院重症医学科，陕西 榆林 719000 |
| 贾娟2 | 2. 榆林市第二医院呼吸与危重症医学科，陕西 榆林 719000 |
| 李莉3 | 3. 榆林市第一医院呼吸与危重症医学科，陕西 榆林 719000； |
| 胡雪婷1 | 1. 延安大学第二附属医院 榆林市第一医院重症医学科，陕西 榆林 719000 |
引用文本：
徐宁,贾娟,李莉,等.血清miRNA-125b联合miRNA-133a早期诊断脓毒症合并急性呼吸窘迫综合征的价值[J].中国临床研究,2023,36(4):537-541.
徐宁,贾娟,李莉,等.血清miRNA-125b联合miRNA-133a早期诊断脓毒症合并急性呼吸窘迫综合征的价值[J].中国临床研究,2023,36(4):537-541.