脓毒症并发急性肾损伤患儿血清miR-128-3p和miR-22-3p的表达变化及其诊断价值

左爽; 周丽娟; 袭雷鸣

doi:10.3969/j.issn.1671-2390.w20-248

脓毒症并发急性肾损伤患儿血清miR-128-3p和miR-22-3p的表达变化及其诊断价值

Changes of serum expression of miR-128-3p and miR-22-3p in septic children complicated with acute kidney injury and their diagnostic values

摘要

摘要: 目的探讨脓毒症并发急性肾损伤（acute kidney injury，AKI）患儿血清miR-128-3p和miR-22-3p的表达变化及其对脓毒症患儿并发AKI的诊断价值。方法选择2017年10月至 2019年 10月在山东省康复医院和山东中医药大学附属医院诊断为脓毒症的患儿118例，根据患儿是否并发AKI分为AKI组（53例）和非AKI组（65例），比较两组患儿血清miR-128-3p、miR-22-3p、血肌酐（serum creatinine，Scr）、胱抑素C（cystatin C，CysC）的水平以及急性生理和慢性健康评分系统Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHEⅡ）评分、序贯器官衰竭估计（sequential organ failure assessment，SOFA）评分、尿量、年龄、体重指数（body mass index，BMI）等临床参数。采用Pearson相关分析miR-128-3p、miR-22-3p和Scr、CysC水平的相关性。采用受试者工作特征（receiver operating characteristic，ROC）曲线分析血清miR-128-3p、miR-22-3p、Scr、CysC水平及4项指标联合对脓毒症患儿并发AKI的诊断价值。结果 AKI组患儿的尿量显著低于非AKI组患儿（P<0.05），而Scr、CysC水平及APACHEⅡ评分、SOFA评分均显著高于非AKI组患儿（P<0.05）。AKI组患儿血清miR-128-3p表达水平明显高于非AKI组患儿（P<0.05），而miR-22-3p表达水平明显低于非AKI组患儿（P<0.05）。相关分析显示，血清miR-128-3p与Scr、CysC均呈显著正相关（P<0.05），而血清miR-22-3p与Scr、CysC均呈显著负相关（P<0.05）。ROC曲线显示，血清miR-128-3p、miR-22-3p、Scr、CysC对脓毒症患儿并发AKI均具有一定诊断价值（AUC=0.835、0.879、0.736、0.758，P<0.05），且4项联合（AUC=0.906，P<0.05）诊断价值更高。结论脓毒症并发AKI患儿血清miR-128-3p表达水平升高，而miR-22-3p表达水平表达降低。血清miR-128-3p、miR-22-3p、Scr、CysC水平联合检测对脓毒症患儿并发AKI患儿具有良好的诊断价值。

Abstract: Objective To explore the changes of serum expression of miR-128-3p/miR-22-3p complicated with acute kidney injury(AKI) and its diagnostic value for AKI in septic children.Methods From October 2017 to October 2019,118 septic children diagnosed at Shandong Rehabilitation Hospital and Affiliated Hospital,Shandong University of Traditional Chinese Medicine were selected and divided into AKI group(n=53) and non-AKI group(n=65) according to whether or not there was any complication of AKI.The serum levels of miR-128-3p,miR-22-3p,serum creatinine(Scr),cystatin C(CysC),acute physiology & chronic health evaluation Ⅱ(APACHE II) score,sequential organ failure assessment(SOFA) score,urinary volume,age,body mass index(BMI) and other clinical parameters were compared between two groups.Pearson's correlation analysis was utilized for examining the correlation between the levels of miR-128-3p,miR-22-3p,Scr and CysC.The curve of receiver operating characteristic(ROC) was plotted for assessing the diagnostic value of serum levels of miR-128-3p,miR-22-3p,Scr and CysC and the combination of four parameters in predicting AKI in septic children.Results Urinary volume of AKI group was significantly lower than that of non-AKI group(P<0.05) while Scr/CysC level,Apache Ⅱ score and SOFA score were significantly higher than those of non-AKI group(P<0.05).The serum level of miR-128-3p was significantly higher in AKI group than that in non-AKI group(P<0.05) while the expression level of miR-22-3p was significantly lower in AKI group than that in non-AKI group(P<0.05).Correlation analysis showed that serum miR-128-3p was positively correlated with Scr/CysC(P<0.05) while serum miR-22-3p negatively correlated with Scr/CysC(P<0.05).ROC curve indicated that serum levels of miR-128-3p,miR-22-3p,Scr and CysC had certain diagnostic values for AKI(AUC=0.835、0.879、0.736、0.758,P<0.05) and the combination of four parameters(AUC=0.906,P<0.05) had a higher diagnostic value.Conclusion The serum expression of miR-128-3p of septic children with AKI increases while the expression of miR-22-3p declines.The combined detection of serum levels of miR-128-3p,miR-22-3p,Scr and CysC has an excellent diagnostic value for septic children complicated with AKI.

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