微小RNA-142-3p在脓毒症患者血清中的表达及其临床意义

目的通过观察脓毒症患者血清中微小RNA-142-3p（miR-142-3p）的表达，探讨其与脓毒症的关系。 方法选取41例脓毒症患者作为研究对象，同期住院的非脓毒症患者20例作为对照组。采用实时荧光定量PCR检测血清中miR-142-3p的表达，酶联免疫吸附剂测定（ELISA）检测白细胞介素6（IL-6）和IL-10的表达。采用Spearman相关分析miR-142-3p与患者临床特点和实验室指标的相关性，受试者工作特征（ROC）曲线评价miR-142-3p、IL-6、IL-10、C反应蛋白（CRP）、前降钙素原（PCT）、白细胞计数和乳酸表达水平对脓毒症的预测价值。 结果脓毒症组患者的白细胞计数（14.4 ± 7.8）× 10⁹/L vs.（8.4 ± 2.1）× 10⁹/L，t = 4.571，P < 0.001]、CRP （127 ± 80）mg/L vs.（80 ± 45）mg/L，t = 2.436，P= 0.018]、乳酸（2.3 ± 1.8）mmol/L vs.（1.5 ± 0.6）mmol/L，t = 2.421，P = 0.019]、PCT 5.70（1.49，26.37）μg/L vs. 0.25（0.10，0.63）μg/L，Z= 75.500，P < 0.001]、IL-6 342.33（64.98，2 618.44）ng/L vs. 14.95（3.21，54.51）ng/L，Z = 84.000，P < 0.001]、IL-10 23.16（6.19，85.56）ng/L vs. 2.75（1.39，5.36）ng/L，Z = 198.500，P = 0.001]和miR-142-3p 95.74（23.19，278.23）vs. 25.64（18.59，56.05），Z = 222.000，P = 0.004]均显著高于对照组。miR-142-3p与乳酸、IL-6、PCT均呈正相关（r = 0.427、0.340、0.309，P = 0.005、0.030、0.049）。根据脓毒症患者28 d生存情况分为存活组（29例）和死亡组（12例）。存活组的急性病生理学与长期健康评价（APACHE）Ⅱ评分（14 ± 6）分vs.（25 ± 6）分]、序贯性器官衰竭估计（SOFA）评分（6.0 ± 2.8）分vs.（10.7 ± 3.5）分]和乳酸（1.6 ± 1.0）mmol/L vs.（3.8 ± 2.6）mmol/L]水平均显著低于死亡组（t = 5.406、4.482、2.835，P均< 0.05）。ROC曲线分析结果显示，miR-142-3p 曲线下面积（AUC）= 0.729，95%CI（0.602，0.856），P = 0.004]、IL-6 AUC = 0.898，95%CI（0.820，0.975），P < 0.001]、CRP AUC = 0.698，95%CI（0.566，0.831），P = 0.013]、PCT AUC = 0.908，95%CI（0.835，0.981），P < 0.001]、IL-10 AUC = 0.758，95%CI（（0.631，0.885），P = 0.001]和白细胞计数AUC = 0.776，95%CI（0.659，0.893），P = 0.001]对脓毒症均有预测价值。 结论脓毒症患者血清中miR-142-3p的表达升高，且与乳酸、IL-6、PCT呈正相关，其在脓毒症发生发展中可能发挥着重要作用。

Expression of microRNA-142-3p in serum of septic patients and its clinical significance

ObjectiveTo observe the expression of serum microRNA-142-3p (miR-142-3p) in septic patients and to explore its relationship with sepsis. MethodsForty-one patients with sepsis were selected as study subjects, and 20 non-septic patients hospitalized in the same period as the control group. The expression of serum miR-142-3p was detected by real-time quantitative PCR, and levels of interleukin-6 (IL-6) and IL-10 were detected by enzyme-linked immunosorbent assay (ELISA). The relationship between miR-142-3p and septic patients' clinical characteristics and laboratory indexes was analyzed by Spearman correlation analysis. In the same time, the predictive value of miR-142-3p, IL-6, IL-10, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count and lactic acid on sepsis was evaluated by the receiver operating characteristic (ROC) curve. ResultsThe white blood cell count (14.4 ± 7.8) × 10⁹/L vs. (8.4 ± 2.1) × 10⁹/L, t = 4.571, P < 0.001], CRP (127 ± 80) mg/L vs. (80 ± 45) mg/L, t = 2.436, P = 0.018], lactic acid (2.3 ± 1.8) mmol/L vs. (1.5 ± 0.6) mmol/L, t = 2.421, P = 0.019], PCT 5.70 (1.49, 26.37) μg/L vs. 0.25 (0.10, 0.63) μg/L, Z = 75.500, P < 0.001], IL-6 342.33 (64.98, 2 618.44) ng/L vs. 14.95 (3.21, 54.51) ng/L, Z = 84.000, P < 0.001], IL-10 23.16 (6.19, 85.56) ng/L vs. 2.75 (1.39, 5.36) ng/L, Z = 198.500, P = 0.001] and miR-142-3p 95.74 (23.19, 278.23) vs. 25.64 (18.59, 56.05), Z = 222.000, P = 0.004] were significantly higher in the sepsis group than in control group. MiR-142-3p was positively correlated with lactic acid, IL-6 and PCT (r = 0.427, 0.340, 0.309; P = 0.005, 0.030, 0.049). Patients with sepsis were divided into the survival group (29 cases) and death group (12 cases) according to their survival conditions on 28 days. The scores of acute physiology and chronic health evaluation (APACHE) Ⅱ (14 ± 6) vs. (25 ± 6)] and sequential organ failure assessment (SOFA) (6.0 ± 2.8) vs. (10.7 ± 3.5)], and lactic acid expression (1.6 ± 1.0) mmol/L vs. (3.8 ± 2.6) mmol/L] in the survival group were significantly lower than those in the death group (t = 5.406, 4.482, 2.835; all P < 0.05). ROC curve analysis showed that miR-142-3p area under the curve (AUC) = 0.729, 95%CI (0.602, 0.856), P = 0.004], IL-6 AUC = 0.898, 95%CI (0.820, 0.975), P < 0.001], CRP AUC = 0.698, 95%CI (0.566, 0.831), P = 0.013], PCT AUC = 0.908, 95%CI (0.835, 0.981), P < 0.001], IL-10 AUC = 0.758, 95%CI (0.631, 0.885), P = 0.001)] and white blood cell count AUC = 0.776, 95%CI (0.659, 0.893), P = 0.001)] have predictive value for sepsis. ConclusionThe expression of serum miR-142-3p in septic patients increases, and it is positively related with lactic acid, IL-6 and PCT, which may play an important role in the development of sepsis.