摘要
目的探讨血清微小RNA-30a-5p(miR-30a-5p)、Runt相关转录因子2(RUNX2)与脓毒症所致急性肺损伤(ALI)患者病情严重程度和预后的关系。方法选取2021年1月至2024年2月新疆医科大学第五附属医院收治的脓毒症所致ALI患者193例(ALI组)和同时期54例单纯脓毒症患者(非ALI组),脓毒症所致ALI患者根据氧合指数分为轻度ALI组(57例)、中度ALI组(64例)、重度ALI组(72例),根据28 d预后情况分为死亡组(71例)和存活组(122例)。采用实时荧光定量PCR检测血清miR-30a-5p水平,酶联免疫吸附试验检测血清RUNX2水平,通过在线数据库预测miR-30a-5p与RUNX2的结合位点。采用Pearson相关系数分析miR-30a-5p与RUNX2在脓毒症所致ALI患者中的相关性,Spearman相关系数分析脓毒症所致ALI患者血清miR-30a-5p、RUNX2水平与氧合指数的相关性;以脓毒症所致ALI患者预后为因变量,采用多因素非条件Logistic回归确定其影响因素,绘制受试者工作特征曲线评价血清miR-30a-5p、RUNX2水平对脓毒症所致ALI患者预后的预测价值。结果与非ALI组比较,ALI组血清miR-30a-5p水平降低,RUNX2水平升高(t=-11.749、11.691,P<0.001)。miR-30a-5p与RUNX2在3'-非翻译区3348~3354处存在结合位点,miR-30a-5p与RUNX2在脓毒症所致ALI患者中呈负相关(r=-0.759,P<0.001)。血清miR-30a-5p水平在重度ALI组、中度ALI组、轻度ALI组中依次降低(P<0.001),RUNX2水平在重度ALI组、中度ALI组、轻度ALI组中依次升高(P<0.001)。脓毒症所致ALI患者氧合指数与血清miR-30a-5p水平呈负相关(r=-0.749,P<0.001),与RUNX2水平呈正相关(r=0.723,P<0.001)。脓毒症所致ALI患者死亡的独立保护因素为氧合指数增加(OR=0.988,95%CI:0.981~0.996,P<0.05),miR-30a-5p水平升高(OR=0.814,95%CI:0.744~0.892,P<0.05),独立危险因素为序贯器官衰竭评估(SOFA)评分增加(OR=1.391,95%CI:1.116~1.734,P<0.05),血乳酸水平升高(OR=1.824,95%CI:1.211~2.748,P<0.05),RUNX2水平升高(OR=1.366,95%CI:1.170~1.595,P<0.05)。血清miR-30a-5p、RUNX2水平联合预测脓毒症所致ALI患者死亡的曲线下面积为0.895(95%CI:0.842~0.934),大于血清miR-30a-5p、RUNX2水平单独预测的0.788(95%CI:0.724~0.844)、0.786(95%CI:0.721~0.842;Z=4.015、3.746,P<0.001)。结论血清miR-30a-5p水平降低、RUNX2水平升高与脓毒症所致ALI患者病情加重和死亡风险增加有关,血清miR-30a-5p、RUNX2水平联合预测脓毒症所致ALI患者预后的价值较高。
Objective To investigate the relationship between serum microRNA-30a-5p(miR-30a-5p),Runt-associated transcription factor 2(RUNX2)and the severity and prognosis of patients with sepsis-induced acute lung injury(ALI).Methods A total of 193 patients with sepsis-induced ALI(ALI group)and 54 patients with simple sepsis(non-ALI group)admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from January 2021 to February 2024 were selected,and the patients with sepsis-induced ALI were divided into a mild ALI group(57 cases),a moderate ALI group(64 cases),and a severe ALI group(72 cases)according to the oxygenation index,and were divided into a death group(71 cases)and a survival group(122 cases)according to the 28 day prognosis situation.Serum miR-30a-5p level was detected by real time fluorescent quantitative PCR,serum RUNX2 level was detected by enzyme-linked immunosorbent assay,and the binding sites of miR-30a-5p and RUNX2 were predicted by online database.Pearson's correlation coefficient was used to analyze the correlation between miR-30a-5p and RUNX2 in patients with sepsis-induced ALI,and Spearman's correlation coefficient was used to analyze the correlation between serum miR-30a-5p,RUNX2 levels and oxygenation index in patients with sepsis-induced ALI.With the prognosis of patients with sepsisinduced ALI as the dependent variable,multivariate unconditional Logistic regression was used to determine their influencing factors,and receiver operating characteristic curve was plotted to evaluate the prognostic value of serum miR-30a-5p and RUNX2 levels in patients with sepsis-induced ALI.Results Compared with the non-ALI group,serum miR-30a-5p level was lower and RUNX2 level was higher in the ALI group(t=-11.749,11.691,P<0.001).There was a binding site between miR-30a-5p and RUNX2 at the 3'-untranslated region 3348-3354.miR-30a-5p was negatively correlated with RUNX2 in patients with sepsis-induced ALI(r=-0.759,P<0.001).The level of serum miR-30a-5p increased in the severe ALI group,the moderate ALI group and the mild ALI group in turn(P<0.001),and the level of RUNX2 decreased in the severe ALI group,the moderate ALI group and the mild ALI group in turn(P<0.001).Oxygenation index was negatively correlated with serum miR-30a-5p level(r=-0.749,P<0.001),and positively correlated with RUNX2 level in patients with sepsis-induced ALI(r=0.723,P<0.001).Independent protective factors for death in patients with sepsis-induced ALI were increased oxygenation index(OR=0.988,95%CI:0.981-0.996,P<0.05),elevated miR-30a-5p(OR=0.814,95%CI:0.744-0.892,P<0.05),and independent risk factors were increased Sequential Organ Failure Assessment(SOFA)score(OR=1.391,95%CI:1.116-1.734,P<0.05),elevated blood lactate(OR=1.824,95%CI:1.211-2.748,P<0.05),and elevated RUNX2(OR=1.366,95%CI:1.170-1.595,P<0.05).The area under the curve of serum miR-30a-5p and RUNX2 levels combined to predict the death in patients with sepsis-induced ALI was 0.895(95%CI:0.842-0.934),which was greater than 0.788(95%CI:0.724-0.844)of serum miR-30a-5p and 0.786(95%CI:0.721-0.842)of RUNX2 levels alone(Z=4.015,3.746,P<0.001).Conclusion Increased miR-30a-5p level and decreased RUNX2 level are associated with the aggravation of the disease and the increased risk of death in patients with sepsis-induced ALI.The combination of serum miR-30a-5p and RUNX2 levels has relatively high value in predicting the prognosis of patients with sepsis-induced ALI.
作者
唐源
张晴晴
李岩
杨健
罗彬
王博青
TANG Yuan;ZHANG Qingqing;LI Yan;YANG Jian;LUO Bin;WANG Boqing(Intensive Care Unit,the Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830000,China;Department of Gynecology,Bayingolin Mongolian Autonomous Prefecture People's Hospital,Korla,Xinjiang 831000,China)
出处
《国际检验医学杂志》
2025年第8期948-954,共7页
International Journal of Laboratory Medicine
基金
新疆维吾尔自治区卫生健康青年医学科技人才专项项目(WJWY-202434)。
