摘要
目的:探讨重症肺炎(SP)肺泡灌洗液微小RNA-127-5p(miR-127-5p)、微小RNA-3686(miR-3686)、可溶性髓系细胞触发受体-1(sTREM-1)表达及与病情、预后关系。方法:选取2017年3月—2019年8月68例SP患者为观察组,同期68例肺炎患者为对照组。比较两组、观察组不同预后(28 d重症肺炎全因死亡、28 d生存)患者肺泡灌洗液miR-127-5p、miR-3686、sTREM-1表达,肺泡灌洗液各指标不同表达(高表达、低表达)SP患者急性生理和慢性健康评分Ⅱ(APACHEⅡ)、临床肺部感染(CPIS)评分,应用Pearson相关分析探讨肺泡灌洗液各指标表达与APACHEⅡ、CPIS评分的关系,绘制受试者工作特征(ROC)曲线及ROC下面积(AUC)探究肺泡灌洗液各指标单一、联合检测对SP重症肺炎全因死亡的预测价值,多元Logistic回归分析SP重症肺炎全因死亡的影响因素。结果:观察组肺泡灌洗液miR-127-5p水平(0.58±0.26)低于对照组(1.23±0.42)(t=10.851,P<0.001),miR-3686水平(1.98±0.46)高于对照组(0.96±0.31)(t=15.163,P<0.001),sTREM-1水平(195.37±48.62)ng/mL高于对照组(26.35±8.20)ng/mL(t=28.268,P<0.001)。肺泡灌洗液miR-127-5p高表达SP患者APACHEⅡ、CPIS评分均低于低表达患者,肺泡灌洗液miR-3686或sTREM-1高表达SP患者APACHEⅡ、CPIS评分均高于低表达患者(均P<0.05)。肺泡灌洗液miR-127-5p表达与APACHEⅡ、CPIS评分呈负相关(r=-0.735,P<0.001;r=-0.727,P<0.001),miR-3686表达与APACHEⅡ、CPIS评分呈正相关(r=0.569,P<0.001;r=0.679,P<0.001),sTREM-1表达与APACHEⅡ、CPIS评分呈正相关(r=0.694,P<0.001;r=0.667,P<0.001)。观察组28 d重症肺炎全因死亡患者肺泡灌洗液miR-127-5p表达低于生存患者,miR-3686、sTREM-1表达高于生存患者(均P<0.05)。预测SP重症肺炎全因死亡的AUC:miR-127-5p为0.757,miR-3686为0.782,sTREM-1为0.816,miR-127-5p+miR-3686+sTREM-1为0.862(均P<0.05)。肺泡灌洗液miR-127-5p为SP 28 d重症肺炎全因死亡的重要保护因素,肺泡灌洗液miR-3686、sTREM-1为SP 28 d重症肺炎全因死亡的重要危险因素(均P<0.05)。结论:SP患者肺泡灌洗液miR-127-5p表达降低,miR-3686、sTREM-1表达升高,与病情、预后密切相关,检测三者表达能为临床评估患者病情程度、预后情况提供参考。
Objective:To investigate the expression of microRNA-127-5p(miR-127-5p),microRNA-3686(miR-3686),soluble myeloid cell trigger receptor-1(sTREM-1)in severe pneumonia(SP)alveolar lavage fluid and its relationship with the disease condition and prognosis.Methods:From March 2017 to August 2019,68 patients with SP were selected as the observation group,and 68 patients with pneumonia in the same period as the control group.The expression of miR-127-5p,miR-3686,and sTREM-1 in the alveolar lavage fluid of patients with different prognosis(28 day severe pneumonia all-cause death and 28 day survival)was compared between the two groups and the observation group,and compared the acute physiology and chronic health scoreⅡ(APACHEⅡ)and clinical pulmonary infection(CPIS)scores of SP patients with different expressions(high expression,low expression)of various indicators of alveolar lavage fluid.Pearson correlation analysis was used to explore the relationship between the expression of various indexes of alveolar lavage fluid and APACHEⅡ and CPIS scores,the receiver operating characteristic(ROC)curve and the area under the ROC(AUC)were plotted to explore the predictive value of the single index and combined detection of the alveolar lavage fluid on severe pneumonia all-cause death.Multiple Logistic regression analysis explored the factors affecting the severe pneumonia all-cause death.Results:The level of miR-127-5p in the alveolar lavage fluid of the observation group(0.58±0.26)was lower than that of the control group(1.23±0.42)(t=10.851,P<0.001),and the level of miR-3686(1.98±0.46)was higher than that of the control group(0.96±0.31)(t=15.163,P<0.001),the level of sTREM-1(195.37±48.62)ng/mL was higher than that in the control group(26.35±8.20)ng/mL(t=28.268,P<0.001).APACHEⅡ,CPIS scoresof SP patients with high expression of alveolar lavage fluid miR-127-5p was lower than those of low expression patients,and patients with high expression of alveolar lavage fluid miR-3686 or sTREM-1 had higher APACHEⅡ and CPIS scores than patients with low expression(all P<0.05).The expression of miR-127-5p in alveolar lavage fluid was negatively correlated with APACHEⅡ and CPIS scores(r=-0.735,P<0.001;r=-0.727,P<0.001),and the expression of miR-3686 was positively correlated with APACHEⅡ and CPIS scores(r=0.569,P<0.001;r=0.679,P<0.001),sTREM-1 expression was positively correlated with APACHEⅡ and CPIS scores(r=0.694,P<0.001;r=0.667,P<0.001).In the observation group,the expression of miR-127-5p in alveolar lavage fluid of 28 day severe pneumonia all-cause death patients was lower than that of surviving patients,and the expression of miR-3686 and sTREM-1 in alveolar lavage fluid was higher than that of surviving patients(all P<0.05).AUC predicting prognosis of SP 28 day severe pneumonia all-cause death showed that miR-127-5p was 0.757,miR-3686 was 0.782,sTREM-1 was 0.816,miR-127-5p+miR-3686+sTREM-1 was 0.862(P<0.05).Alveolar lavage fluid miR-127-5p was an important protective factor for SP patients at 28 days severe pneumonia all-cause death,alveolar lavage fluid miR-3686 and sTREM-1 were important risk factors for SP patients at 28 days severe pneumonia all-cause death(all P<0.05).Conclusion:The expression of miR-127-5p is decreased and the expression of miR-3686 and sTREM-1 is increased in SP patients with alveolar lavage fluid,which is closely related to the condition and prognosis.The detection of three genes can provide a reference for clinical evaluation of the patients'condition and prognosis.
作者
张咏梅
何俊
马亚青
黄伸伸
王同生
ZHANG Yong-mei;HE Jun;MA Ya-qing;HUANG Shen-shen;WANG Tong-sheng(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital,Henan University of Science and Technology,Luoyang 471003,China)
出处
《天津医科大学学报》
2021年第4期354-359,共6页
Journal of Tianjin Medical University
基金
河南省医学科技攻关计划(201803146)。
