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Received:August 17, 2023 Published Online:October 20, 2023
Received:August 17, 2023 Published Online:October 20, 2023
中文摘要: 目的 探讨脓毒症多器官功能衰竭(SMOF)患者血清中微小核糖核酸（microRNA， miR）-205/23b、脂蛋白相关磷脂酶A2(Lp-PLA2)的表达及临床意义。
方法 选择2019年9月至2022年9月上海健康医学院附属崇明医院收治的脓毒症患者127例进行回顾性研究，根据入院72 h内SMOF发生情况分为非SMOF组（n=88）和SMOF组（n=39）。采用qPCR法检测两组患者入院后24 h内血清miR-205、miR-23b表达水平；采用ELISA法测定Lp-PLA2水平；分析脓毒症患者发生SMOF的危险因素，三指标与SMOF的相关性及各指标对SMOF的预测效能。
结果 与非SMOF组、双器官衰竭患者比较，SMOF组、器官衰竭>2个患者的Lp-PLA2水平显著升高（P<0.01），miR-205、miR-23b水平显著降低（P<0.05）；多因素logistic回归分析显示，SOFA评分升高、Lp-PLA2升高及miR-205、miR-23b降低是SMOF的独立危险因素（P＜0.05）；Spearman相关分析显示，血清Lp-PLA2水平与SMOF呈正相关（P<0.01），miR-205、miR-23b分别与SMOF呈负相关（P<0.01）；ROC曲线显示，血清miR-205、miR-23b、Lp-PLA2水平及SOFA评分分别以0.64、0.62、371.80 ng/mL、4.64分为截断值时，预测SMOF的AUC分别0.625、0.639、0.672和0.780；而四项指标联合预测SMOF的AUC为0.917,且显著优于上述四指标单独预测（Z=5.192，5.024，4.620，3.895，P＜0.01）。
结论 SMOF患者血清中miR-205、miR-23b呈低水平表达、Lp-PLA2呈高水平表达，其表达水平对于SMOF有一定预测作用，且与病情程度关联密切，有临床应用的潜在价值。
Abstract:ObjectiveTo investigate the expression and clinical significance of serum microRNA(miR)-205/23b and lipoprotein associated phospholipase A2 (Lp-PLA2) in patients with septic multiple organ failure (SMOF).
Methods A total of 127 patients with sepsis admitted to Chongming Hospital affiliated to Shanghai University of Medicine Sciences Health Sciences from September 2019 to September 2022 were selected for a retrospective study, and were divided into non-SMOF group (n=88) and SMOF group (n=39) according to the occurrence of SMOF within 72h after admission. The expression levels of serum miR-205, miR-23b were detected by qPCR, and Lp-PLA2 was detected by ELISA within 24 h after admission. The risk factors affecting SMOF, the correlation between the three indicators and SMOF, and the predictive efficacy of each index on SMOF were analyzed.
〖JP+1〗Results Compared with the non-SMOF group and patients with double organ failure, the levels of Lp-PLA2 significantly increased in the SMOF group and the patients with > 2 organ failure (P<0.01), and the levels of miR-205 and miR-23b significantly reduced (P<0.05). The multivariate logistic regression analysis showed that the increase of SOFA score and Lp-PLA2, and the decrease of miR-205 and miR-23b were independent risk factors for SMOF (P<0.05). Spearman correlation analysis showed that serum Lp-PLA2 level was positively correlated with SMOF (P<0.01), while miR-205 and miR-23b were negatively correlated with SMOF (P<0.01). ROC curve showed that when the cutoff values of serum miR-205, miR-23b, Lp-PLA2 and SOFA score were 0.64, 0.62, 371.80 ng/mL and 4.64, respectively, their AUC for predicting SMOF were 0.625, 0.639, 0.672 and 0.780, respectively. However, the AUC of the combination of four indicators for predicting SMOF was 0.917， which was significantly superior to the above four individual predictions (Z=5.192, 5.024, 4.620, 3.895, P<0.01). Conclusion The expression levels of miR-205 and miR-23b in the serum of patients with SMOF are low, and Lp-PLA2 is high. Their expression levels can predict SMOF to some extent, and are closely related to the severity of the disease, which has potential value in clinical application.
keywords: Sepsis Multiple organ failure MicroRNA-205 MicroRNA-23b Lipoprotein associated phospholipase A2 Assessment of disease state
文章编号： 中图分类号：R631 文献标志码：A
基金项目:
| Author Name | Affiliation |
| LIU Liming， YANG Zijian， LIU Zhihan | Department of Critical Care Medicine, Chongming Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 202150, China |
| Author Name | Affiliation |
| LIU Liming， YANG Zijian， LIU Zhihan | Department of Critical Care Medicine, Chongming Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 202150, China |
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