血清miR-133a在脓毒症心肌损伤患者诊断及预后评估中的临床价值

目的探讨miR-133a在脓毒症心肌损伤患者临床诊断及预后评估中的价值。方法选取脓毒症心肌损伤患者50例作为研究对象（观察组），根据入住ICU 28 d内是否存活，分为存活组（30例）及死亡组（20例）。另选取该院体检中心健康体检者25例作为对照组；收集其临床资料及相关观察指标，检测患者入组后第24、48、72小时患者血清心肌肌钙蛋白Ｉ（cTnI）、CK-MB，计算急性生理学与慢性健康状况评分系统 Ⅱ（APACHEⅡ评分）及序贯器官衰竭评分（SOFA评分），运用实时荧光定量多聚核苷酸链式反应技术（qRT-PCR）检测所有受试者血清miR-133a的表达水平，分析其与cTnI、APACHEⅡ评分的相关性，分析血清miR-133a在脓毒症心肌损伤患者诊断及预后评估中的价值。结果观察组与对照组在性别、年龄、体质指数方面差异无统计学意义（P>0.05）。与对照组相比，观察组心率、平均动脉压、WBC、乳酸、cTnI、CK-MB、BNP、APACHEⅡ评分、SOFA评分均明显升高（P<0.05）。观察组血清miR-133a表达水平与对照组相比明显升高，差异有统计学意义（P<0.05）。在入组24、48、72 h时，死亡组患者的cTnI、CK-MB浓度以及APACHEⅡ评分、SOFA评分、miR-133a表达水平均明显高于存活组，差异有统计学意义（P<0.05），各个时间点检测的miR-133a表达水平和cTnI含量以及APACHEⅡ评分均呈显著正相关，差异有统计学意义（P<0.05）。乳酸、APACHEⅡ评分、cTnI、miR-133a表达水平等因素是脓毒症心肌损伤患者预后的影响因素（P<0.05）。结论脓毒症心肌损伤患者血清miR-133表达水平与cTnI及APACHE Ⅱ评分相关性好，可以作为诊断脓毒症心肌损伤的潜在生物学标记物，对预测疾病严重程度及预后有一定的临床价值。

Clinical value of miR-133a in the diagnosis and prognosis assessment of patients with sepsis myocardial injury

ObjectiveTo investigate the significance of miR-133a in the diagnosis and prognosis assessment of patients with sepsis myocardial injury. Methods Fifty patients with sepsis myocardial injury admitted to ICU of the Second Affiliated Hospital of Nantong University from March 2018 to May 2009 were selected (experimental group). According to whether they survived in ICU within 28 days, they were divided into survival group (30 cases) and death group (20 cases); while 25 healthy people in physical examination center of the hospital were selected as the control group. Their clinical data were collected. The serum cardiac troponin I (cTnI) and CK-MB were measured 24 h, 48 h and 72 h after admission. The acute physiology and chronic health score system Ⅱ (APACHE Ⅱ score) and sequential organ failure score (SOFA score) were calculated. The expression level of miR-133a in serum was measured by real-time fluorescent quantitative polynucleotide chain reaction (qRT-PCR). The correlations between miR-133a and cTnI or Apache Ⅱ score were analyzed. ResultsThere was no significant difference in sex, age or BMI between the experimental group and the control group (P>0.05). Compared with the control group, the heart rate, mean arterial pressure, WBC, lactate, cTnI, CK-MB, BNP, Apache Ⅱ and SOFA scores of the experimental group were significantly higher (P<0.05). The expression level of miR-133a in the experimental group was significantly higher than that in the control group (P<0.05). At 24 h, 48 h and 72 h, the concentrations of cTnI, CK-MB, Apache Ⅱ score, SOFA score and miR-133a of the death group were significantly higher than those of the survival group (P<0.05). The expression level of mir-133a, the content of cTnI and Apache Ⅱ were significantly positively correlated at each time point (P<0.05). Lactate, Apache Ⅱ score, cTnI and miR-133a expression were the prognostic influencing factors for sepsis myocardial injury (P<0.05). ConclusionThe serum expression level of miR-133 of patients with sepsis myocardial injury has good correlations with cTnI and APACHE Ⅱ scores. It can be used as a new diagnostic biomarker for sepsis myocardial injury, it may be helpful for predicting the severity and prognosis of the disease.