国际麻醉学与复苏杂志   2019, Issue (8): 0-0
    
微小RNA-133a和微小RNA-499a-5p在脓毒性心肌病中的诊断和预后价值
薛雨晨, 薛晓梅, 何斌1()
1.上海交通大学医学院附属新华医院
Diagnostic and predictive value of micro RNA-133a and micro RNA-499a-5p in patients with sepsis induced cardiomyopathy
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摘要:

目的 探讨微小RNA(micro RNA, miR)-133a和miR-499a-5p对脓毒性心肌病(sepsis-induced cardiomyopathy,SIC)的诊断及预后评估价值。 方法 收集70 例脓毒症患者血液样本,根据诊断标准分为SIC组(54例)和对照组(脓毒症未发生心肌病,16例)。记录患者一般情况,用实时定量荧光PCR技术检测血清miR-133a和miR-499a-5p的表达情况,随访28 d,记录患者生存情况,并比较两组患者28 d病死率。采用Pearson相关性分析检验miR-133a和miR-499a-5p与血清肌钙蛋白I (troponin I, cTnI)、肌酸激酶同工酶(creatine kinase-MB, CK-MB)、N末端B型钠尿肽前体(N-terminal B-type natriuretic peptide, NT-proBNP)及左室射血分数(left ventricular ejection fraction, LVEF)的相关性;受试者工作特征曲线 (receiver operating characteristic, ROC曲线)分析比较miR-133a和miR-499a-5p对SIC的诊断价值;多因素Logistic回归分析SIC患者28 d病死率的危险因素;ROC曲线分析危险因素对患者28 d病死率的预测价值。 结果 与对照组比较,SIC组患者miR-133a和miR-499a-5p表达升高,28 d病死率增高(P<0.05)。Pearson相关分析结果显示:miR-133a和miR-499a-5p与cTnI呈正相关(miR-133a,r=0.329,P=0.005;miR-499a-5p,r=0.574,P=0.000)。ROC曲线分析结果显示:miR-133a、miR-499a-5p以及miR-133a和miR-499a-5p联合检测诊断SIC的ROC曲线下面积分别为0.676、0.737和0.758。多因素回归结果显示:miR-133a为SIC患者28 d病死率的独立危险因素。ROC曲线分析结果显示,miR-133a预测患者28 d病死率的ROC曲线下面积为0.826(95%CI 0.703~0.948)。 结论 miR-133a和miR-499a-5p可作为诊断SIC的生物标志物,miR-133a对SIC患者的28 d病死率具有预测价值。

关键词: 脓毒症;脓毒性心肌病;微小RNA-133a;微小RNA-499a-5p;生物标志
Abstract:

Objective To investigate the value of micro RNA (miR)-133a and miR-499a-5p in diagnosing sepsis-induced cardiomyopathy (SIC) and predicting mortality in patients with SIC. Methods Blood samples collected from 70 sepsis patients with sepsis were included and divided into SIC group(n=54) and control group(n=16, sepsis without cardiomyopathy) according to diagnostic criteria to calculate the incidence of SIC. Blood samples were examined for serum levels of miR-133a and miR-499a-5p using Real-Time polymerase chain reaction (PCR) and baseline data were recorded. The comparison was made between SIC group and control group. The patients were followed up for 28 d to record their survival. Pearson correlation analysis was used to test the correlations of miR-133a and miR-499a-5p with troponin I (cTnI), creatine kinase-MB (CK-MB), N-terminal B-type natriuretic peptide(NT-proBNP) and left ventricular ejection fraction (LVEF) in patients with SIC. The diagnostic value of miR-133a and miR-499a-5p for SIC was analyzed using receiver operating characteristic(ROC) curve. Multivariate Logistic regression analysis was used to analyze the correlations of miR-133a , miR-499a-5p and other risk factors with the 28 d mortality in patients with sepsis. The predictive value of these indicators for evaluating the prognosis of SIC was analyzed using ROC curve. Results The expression levels of miR-133a and miR-499a-5p in patients with SIC were both significantly higher than the expression levels in patients without SIC(P<0.05). Pearson correlation analysis showed that miR-133a and miR-499a-5p were positively correlated with cTnI levels (miR-133a, r=0.329, P=0.005; miR-499a-5p, r=0.574, P=0.000). The area under the ROC curve of miR-133a, miR-499a-5p and miR-133a combined with miR-499a-5p was 0.676, 0.737 and 0.758. During the follow-up period for 28 d, 19 of the 54 (35.2%) SIC patients died. Logistic regression analysis indicated that miR-133a was independent risk factor for the 28 d mortality of SIC patients. The ROC curve analysis showed that the area under the curve of miR-133a was 0.826 (95%CI 0.703~0.948). Conclusions MiR-133a and miR-499a-5p can be novel biomarkers for the diagnosis of SIC. miR-133a has good predictive value in assessing the 28 d mortality of patients with SIC.

Key words: Sepsis; Sepsis-induced cardiomyopathy; Micro RNA-133a; Micro RNA-499a-5p; Biomarker