摘要
目的观察脓毒症并发急性肾损伤(AKI)患儿血清miR-182-5p、miR-21-3p的表达变化,并探讨其临床意义。方法113例脓毒症患儿,根据是否并发AKI分为AKI组89例和NAKI组24例,采集患儿入院后次日清晨空腹静脉血,采用实时荧光定量法检测血清miR-182-5p、miR-21-3p,采用ELISA法检测血清肾功能指标肾损伤分子-1(KIM-1)、胱抑素C(Cys-C)、肌酐(Scr),分析血清miR-182-5p、miR-21-3p表达与脓毒症并发AKI患儿血清KIM-1、Cys-C、Scr水平的相关性,采用多因素Logistics回归分析法分析脓毒症并发AKI的影响因素,绘制受试者工作特征曲线分析血清miR-182-5p、miR-21-3p表达对脓毒症患儿并发AKI的预测价值。结果AKI、NAKI组血清miR-182-5p相对表达量分别为1.54(0.98,1.98)、0.35(0.28,0.39),血清miR-21-3p相对表达量分别为2.66(1.83,3.28)、0.85(0.75,1.00),二者比较,P均<0.05。脓毒症并发AKI患儿的血清miR-182-5p、miR-21-3p表达与血清KIM-1、Cys-C、Scr水平均呈正相关(P均<0.05)。与NAKI组比较,AKI组患者24小时尿量少,血清KIM-1、Cys-C、Scr水平升高,急性生理和慢性健康评估Ⅱ评分、脓毒症相关的序贯器官衰竭评估评分增加(P均<0.05)。血清miR-182-5p、miR-21-3p、KIM-1、Cys-C、Scr为脓毒症患儿并发AKI独立危险因素(OR分别为1.530,1.247,1.249,1.473,1.741;95%CI分别为1.134~1.913,1.011~1.707,1.021~1.529,1.103~2.987,1.062~3.517;P均<0.05)。miR-182-5p+miR-21-3p联合预测脓毒症患儿并发AKI的曲线下面积明显高于血清miR-182-5p、miR-21-3p单独预测(Z=3.039、2.864,P=0.002、0.004)。结论脓毒症并发AKI患儿血清miR-182-5p、miR-21-3p表达降低。血清miR-182-5p、miR-21-3p表达降低是脓毒症患儿并发AKI的独立危险因素。血清miR-182-5p、miR-21-3p可作为脓毒症患儿并发AKI的预测指标。
Objective To observe the changes in the expression of serum miR-182-5p and miR-21-3p in children with sepsis complicated with acute kidney injury(AKI),and to explore their clinical significance.Methods Totally 113 children with sepsis were divided into the AKI group of 89 cases and the NAKI group of 24 cases according to whether they had AKI.The fasting venous blood was collected from the children on the day after admission.Serum miR-182-5p and miR-21-3p were measured by real-time fluorescence quantification,and serum renal function indicators kidney injury molecule-1(KIM-1),cystatin C(Cys-C),and creatinine(Scr)were measured by ELISA.Multifactorial Logistic regression analysis was used to analyze the factors influencing the complications of AKI in sepsis.The predictive value of serum miR-182-5p and miR-21-3p expression in children with sepsis and AKI was analyzed by receiver operating characteristic(ROC)curve.Results The relative expression of serum miR-182-5p was 1.54(0.98,1.98)and 0.35(0.28,0.39)in AKI and NAKI groups,respectively,and the relative expression of serum miR-21-3p was 2.66(1.83,3.28)and 0.85(0.75,1.00)in AKI and NAKI groups,respectively,with statistically significant differences between groups(all P<0.05).Serum miR-182-5p and miR-21-3p expression levels were positively correlated with serum KIM-1,Cys-C and Scr levels in children with sepsis complicated with AKI(all P<0.05).Compared with the NAKI group,patients in the AKI group had lower 24-hour urine output,higher serum KIM-1,Cys-C and Scr levels,and higher acute physiological and chronic health assessment II scores,and sepsis-related sequential organ failure assessment scores(all P<0.05).Serum miR-182-5p,miR-21-3p,KIM-1,Cys-C and Scr were independent risk factors for AKI complications in children with sepsis(OR 1.530,1.247,1.249,1.473,and 1.741,respectively;95%CI:1.134-1.913,1.011-1.707,1.021-1.529,1.103-2.987,and 1.062-3.517,respectively;all P<0.05).The AUC of miR-182-5p and miR-21-3p combined in predicting sepsis complicated with AKI was higher than that of serum miR-182-5p and miR-21-3p alone(Z=3.039,2.864,P=0.002,0.004).Conclusions Serum miR-182-5p and miR-21-3p are low expressed in children with sepsis complicated with AKI.The decreased expression of serum miR-182-5p and miR-21-3p are an independent risk factors for AKI in children with sepsis.Serum miR-182-5p and miR-21-3p can be used as predictors of AKI in children with sepsis.
作者
郭艳梅
李君娥
孙慧
霍习敏
徐梅先
王晓冬
GUO Yanmei;LI Jun'e;SUN Hui;HUO Ximin;XU Meixian;WANG Xiaodong(The First Department of Critical Care Medicine,Hebei Children's Hospital,Shijiazhuang 050031,China)
出处
《山东医药》
CAS
2021年第30期29-33,共5页
Shandong Medical Journal
基金
河北省医学科学研究重点课题计划项目(20170385)。
