摘要
目的筛查感染性休克并发心肌损伤患者血浆微小RNA(miRNA)表达谱并分析其预测价值。方法选取2018年5月-2020年4月南平市第一医院收治的感染性休克患者120例为研究对象,依据是否合并心肌损伤分为研究组(合并心肌损伤,n=48)、对照组(未合并心肌损伤,n=72),比较其基线资料、实验室指标,对受试者血浆常规抽提总RNA,经miRNA芯片检测miRNA表达谱,对差异表达的miRNA进行实时荧光定量聚合酶链反应(qRT-PCR)验证,分析差异表达的miRNA与实验室指标的相关性,绘制ROC曲线分析其预测价值。结果研究组心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、氮末端脑钠肽前体(NT-proBNP)、C-反应蛋白(CRP)、降钙素原(PCT)及美国纽约心脏病学会(NYHA)分级均高于对照组,左室射血分数(LVEF)低于对照组(P<0.05);研究组血浆miRNA表达谱中14个miRNA明显差异表达,其中9个miRNA上调(miRNA-155、miRNA-497、miRNA-124-3p、miRNA-140等),5个miRNA下调(miRNA-214、miRNA-494-3p、miRNA-133a等),与qRT-PCR检测结果基本相符;随NYHA分级增加,研究组miRNA-155、miRNA-497、miRNA-124-3p表达水平增加,而miRNA-214、miRNA-494-3p、miRNA-133a表达水平下降(P<0.05);感染性休克致心肌损伤患者的miRNA-155、miRNA-497表达水平与cTnI、CK-MB、NT-proBNP呈正相关,miRNA-214、miRNA-133a表达水平与cTnI、NT-proBNP呈负相关(P<0.05);受试者工作特征(ROC)曲线显示,miRNA-155、miRNA-497、miRNA-214、miRNA-133a联合实验室指标预测感染性休克致心肌损伤的敏感度、特异度、准确度、曲线下面积分别为0.821、0.784、0.805、0.824。结论感染性休克致心肌损伤患者血浆部分miRNA表达有明显改变,且与患者实验室指标有一定关系,可作为感染性休克进展的新型生物标志物。
OBJECTIVE To screen the plasma microRNA(miRNA)expression profile of patients with myocardial injury caused by septic shock,and analyze its predictive value.METHODS A total of 120 patients with septic shock admitted to Nanping First Hospital from May 2018 to Apr.2020 were selected as the research subjects,and were divided into study group(combined with myocardial injury,n=48)and control group(without myocardial injury,n=72)according to whether it was combined with myocardial injury.The baseline data and laboratory indicators of the two groups were compared.Then,the total RNA was routinely extracted from the plasma samples of subjects,and the miRNA expression profile were detected using miRNA chips.Real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR)was performed to verify differentially expressed miRNAs,the correlation between differentially expressed miRNAs and laboratory indicators was analyzed,and ROC curves were drawn to analyze their predictive value.RESULTS The cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),N-terminal-brain natriuretic peptide precursor(NT-proBNP),C-reactive protein(CRP),procalcitonin(PCT)and New York Heart Association(NYHA)grades in the study group were signigifcantly higher than those in the control group,while left ventricular ejection fraction(LVEF)was signigifcantly lower than that in the control group(P<0.05).In the the study group,14 miRNAs were significantly differentially expressed in the plasma miRNA expression profile,of which,9 miRNAs were up-regulated(miRNA-155,miRNA-497,miRNA-124-3 p,miRNA-140,etc.),and 5 miRNAs were down-regulated(miRNA-214,miRNA-494-3 p,miRNA-133 a,etc.),which were basically consistent with the qRT-PCR test results.With the increase of NYHA grade,the expression levels of miRNA-155,miRNA-497 and miRNA-124-3 p increased,while the expression levels of miRNA-214,miRNA-494-3 p and miRNA-133 a decreased in the study group(P<0.05).The expression levels of miRNA-155 and miRNA-497 in patients with myocardial injury caused by septic shock were positively correlated with cTnI,CK-MB,and NT-proBNP.The expression levels of miRNA-214 and miRNA-133 a were negatively correlated with cTnI and NT-proBNP(P<0.05).The receiver operating characteristic(ROC)curve showed that the sensitivity,specificity,accuracy and area under the curve of miRNA-155,miRNA-497,miRNA-214,and miRNA-133 a combined with laboratory indicators for predicting myocardial injury caused by septic shock were 0.821,0.784,0.805,and 0.824,respectively.CONCLUSION The expression of some plasma miRNAs of patients with myocardial injury caused by septic shock were changed obviously,and were related to the patients′laboratory indicators,which could be used as new biomarkers for the progression of septic shock.
作者
黄秋杰
谢辉
杨健
李珊
周钦伟
HUANG Qiu-jie;XIE Hui;YANG Jian;LI Shan;ZHOU Qin-wei(Nanping First Hospital,Nanping,Fujian 353000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第20期3115-3120,共6页
Chinese Journal of Nosocomiology
基金
福建省科研基金资助项目(201921411)。
