血浆miRNA-122a、miRNA-146a、miRNA-155a对脓毒症诊断及预后评估价值的研究

发布时间：2018-03-16 23:33

  本文选题：脓毒症　切入点：miRNA　出处：《河北大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的:脓毒症治疗虽然有了很大的提高,但仍是ICU主要死亡原因,严重威胁着人类健康。其中一个主要原因是脓毒症早期识别困难,因此如果找到脓毒症诊断的特异性生物标记物,将改善脓毒症诊断和治疗,提高患者生存率。最近研究发现miRNA与多种疾病有关,且在脓毒症患者中特异性表达。本研究旨在通过测量脓毒症患者血浆中miRNA-122a、miRNA-146a、miRNA-155a表达量,验证其是否可以作为脓毒症诊断标记物,为脓毒症早期诊断提供理论依据。方法:选择103例脓毒症患者作为研究对象,分为脓毒症组(71例)和脓毒症休克组(32例),选30名健康人作为对照组。采用实时荧光定量(RT-PCR)测定血浆miRNA-122a、miRNA-146a、miRNA-155a表达量,并收集研究对象基本临床资料。应用受试者工作特征曲线(ROC)评估miRNA对脓毒症的诊断价值。根据患者28天转归情况分为存活组(75例)、死亡组(28例),采用二元logistic回归分析影响脓毒症患者预后的危险因素。结果:(1)健康组、脓毒症组与脓毒症休克组血浆miRNA-122a、miRNA-155a表达量呈依次升高(P0.05),而miRNA-146a呈依次降低(P0.05)。ROC曲线分析显示,血浆miRNA-122a、miRNA-146a、miRNA-155a表达量诊断脓毒症的ROC曲线下面积(AUC)分别为0.787[95%可信区间(95%CI)=0.703~0.872]、0.732(95%CI=0.629~0.835)和0.740(95%CI=0.635~0.844)。(2)与存活组比较,单因素分析显示,28天死亡组疾病严重程度、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、CRP(C-反应蛋白)、PCT(降钙素原)、Lac(乳酸)、miRNA-122a、miRNA-155a均明显升高(P0.05),miRNA-146a表达量明显降低(P0.05);而两组间性别、年龄、WBC(白细胞计数)差异均无统计学意义(P0.05)。二元logistic回归多因素分析显示,严重程度、SOFA评分、APACHEⅡ评分、miRNA-122a、miRNA-155a是影响预后的危险因素。结论:(1)血浆miRNA-122a、miRNA-146a、miRNA-155a可作为脓毒症诊断标志物。(2)血浆miRNA-122a、miRNA-146a、miRNA-155a对判断脓毒症严重程度存在指导意义(3)血浆miRNA-122a、miRNA-155a是脓毒症的独立危险因素,对脓毒症的预后存在预警作用。
[Abstract]:Background and objective: although the treatment of sepsis has been greatly improved, it is still the leading cause of death in ICU and a serious threat to human health. So if you find a specific biomarker for the diagnosis of sepsis, it will improve the diagnosis and treatment of sepsis and improve the survival rate of patients. The aim of this study was to measure the expression of miRNA-122 aRNA-146asimiRNA-155a in plasma of septic patients to determine whether it can be used as a diagnostic marker for sepsis. Methods: 103 patients with sepsis were selected as subjects. There were 71 cases of sepsis group and 32 cases of septic shock group. 30 healthy persons were selected as control group. The expression of miRNA-122ahmiRNA-146a miRNA-155a in plasma was measured by real-time fluorescence quantitative analysis (RT-PCR). The diagnostic value of miRNA in sepsis was evaluated by using the operating characteristic curve of subjects. According to the outcome of 28 days, the patients were divided into survival group (n = 75) and death group (n = 28). Binary logistic regression was used. The risk factors influencing the prognosis of sepsis patients were analyzed. In septic group and septic shock group, the expression of miRNA-122 aRNA-155a in plasma increased in turn, while miRNA-146a decreased in turn (P 0.05). The results showed that the area under the ROC curve of plasma miRNA-122 aRNA-146aRNA-155a expression in septic diagnosis was 0.787 (95% confidence interval 95CI95CI95CI0.6290.0.835) and 0.740 ~ 95CI0.635 ~ (0.844)), respectively, compared with survival group. Univariate analysis showed the severity of the disease in the 28-day death group. Sequential organ failure assessment of SOFAA, acute physiology and chronic health evaluation 鈪，

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