南方医科大学学报

南方医科大学学报 ›› 2017, Vol. 37 ›› Issue (05): 646-.

• • 上一篇    下一篇

miRNA-29a和miRNA-10a-5p 对脓毒症所致急性肾损伤患者28 d 死亡率的预测价值

霍锐，戴敏，樊艺，周竞峥，李莉，祖建   

  • 出版日期:2017-05-20 发布日期:2017-05-20

Predictive value of miRNA-29a and miRNA-10a-5p for 28-day mortality in patients with sepsis-induced acute kidney injury

  • Online:2017-05-20 Published:2017-05-20

HTML

PDF

1998

摘要： 目的探讨miR-29a和miR-10a-5p对评估脓毒症伴有急性肾损伤（AKI）患者28 d死亡率的预测价值。方法收集我院124 例急性肾损伤患者（AKI）血清样本，分为观察组（74例脓毒症所致AKI）和对照组（脓毒症无AKI）41例，记录患者一般情况，并 用RT-PCR检测其中miR-29a和miR-10a-5p的表达情况，随访28 d，记录患者生存情况，采用Pearson相关分析检验miR-29a和 miR-10a-5p 与观察组患者血清肌酐（Scr）、胱抑素C（Cys-C）和肾损伤分子1（KIM-1）的相关性；多因素Logistic 回归分析 miR-29a、miR-10a-5p、Scr、Cys-C、KIM-1以及其他危险因素与脓毒症患者28 d死亡率的相关性。ROC曲线分析比较miR-29a 和miR-10a-5p与Cys-C和Scr在脓毒症患者预后评估中的价值，最后进一步用统计学方法分析miR-29a和miR-10a-5p联合与 Scr及Cys-C联合对脓毒症患者预后评估的价值。结果随访28 d后：（1）74例AKI患者中21例死亡，占整体人数的35.53%；（2） 相比于生存组，死亡组患者血清Scr及Cys-C表达上升（P<0.05），死亡组患者血清中miR-29a和miR-10a-5p表达升高，有统计学 意义（P<0.05）；（3）Pearson相关分析结果显示miR-29a和miR-10a-5p分别与Scr、Cys-C及KIM-1表达呈正相关；（4）多因素回归 结果显示，miR-29a和miR-10a-5p均为脓毒症患者死亡的独立危险因素；（5）ROC曲线分析结果显示miR-29a和miR-10a-5p曲 线下面积（auRoC）分别为0.82（95%CI，0.71-0.89）及0.75（95%CI，0.64-0.85），Cys-C、Scr和KIM-1曲线下面积分别为0.72（95% CI，0.66-0.86）、0.71（95%CI，0.63-0.84）及0.81（95%CI，0.72-0.81）。miR-29a及miR-10a-5p二者联合检测的auROC值优于单一 检测miR-29a、miR-10a-5p、Cys-C、Scr和KIM-1（P<0.05）。结论miR-29a和miR-10a-5p在评估脓毒症患者死亡率时具有良好 的预测价值。

Abstract: Objective To investigate the value of miR-29a and miR-10a-5p in predicting 28-day mortality in patients with sepsis-induced acute kidney injury. Methods Seventy-four patients with sepsis-induced acute kidney injury (AKI) and 41 patients with sepsis but without AKI (control) were examined for serum levels of miR-29a and miR-10a-5p using RT-PCR. The patients were followed up for 28 days to record their survival. Pearson correlation analysis was used to test the correlations of miR-29a and miR-10a-5p with serum creatinine (Scr), cystatin C (Cys-C), and KIM-1 in patients with AKI. Multivariate logistic regression analysis was used to analyze the correlations of miR-29a, miR-10a-5p, Scr, Cys-C, KIM-1 and other risk factors with the 28-day mortality in patients with sepsis. The predictive value of these indicators for evaluating the prognosis of patients with sepsis was analyzed using ROC curve, and miR-29a combined with miR-10a-5p was assessed for their value in predicting the prognosis of the patients. Result During the follow-up for 28 days, 21 of the 74 (35.53%) AKI patients died. Compared with the survivors, the patients died within 28 days showed significantly increased serum levels of Scr , Cys-C, KIM-1, miR-29a, and miR-10a-5p (P<0.05). Pearson correlation analysis showed that miR-29a and miR-10a-5p were positively correlated with serum Scr, Cys-C, and KIM-1 levels; multivariate regression analysis identified miR-29a and miR-10a-5p as the independent risk factors for mortality in the septic patients. The ROC curve analysis showed that the area under the curve (AUC) of miR-29a and miR-10a-5p was 0.82 (95%CI: 0.71-0.89) and 0.75 (95%CI: 0.64-0.85), and that of Scr, Cys-C and KIM-1 was 0.72 (95%CI: 0.66-0.86) , 0.71 (95% CI: 0.63-0.84) and 0.81 (95% CI: 0.72-0.81), respectively. The AUC of miR-29a combined with miR-10a-5p was significantly greater than that of miR-29a, miR-10a-5p, Scr, Cys-C and KIM-1 alone (P<0.05). Conclusion miR-29a and miR-10a-5p have good predictive value in assessing the 28-day mortality of patients with sepsis.