發(fā)布時間：2018-03-16 23:33

  本文選題：膿毒癥　切入點：miRNA　出處：《河北大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的:膿毒癥治療雖然有了很大的提高,但仍是ICU主要死亡原因,嚴(yán)重威脅著人類健康。其中一個主要原因是膿毒癥早期識別困難,因此如果找到膿毒癥診斷的特異性生物標(biāo)記物,將改善膿毒癥診斷和治療,提高患者生存率。最近研究發(fā)現(xiàn)miRNA與多種疾病有關(guān),且在膿毒癥患者中特異性表達(dá)。本研究旨在通過測量膿毒癥患者血漿中miRNA-122a、miRNA-146a、miRNA-155a表達(dá)量,驗證其是否可以作為膿毒癥診斷標(biāo)記物,為膿毒癥早期診斷提供理論依據(jù)。方法:選擇103例膿毒癥患者作為研究對象,分為膿毒癥組(71例)和膿毒癥休克組(32例),選30名健康人作為對照組。采用實時熒光定量(RT-PCR)測定血漿miRNA-122a、miRNA-146a、miRNA-155a表達(dá)量,并收集研究對象基本臨床資料。應(yīng)用受試者工作特征曲線(ROC)評估m(xù)iRNA對膿毒癥的診斷價值。根據(jù)患者28天轉(zhuǎn)歸情況分為存活組(75例)、死亡組(28例),采用二元logistic回歸分析影響膿毒癥患者預(yù)后的危險因素。結(jié)果:(1)健康組、膿毒癥組與膿毒癥休克組血漿miRNA-122a、miRNA-155a表達(dá)量呈依次升高(P0.05),而miRNA-146a呈依次降低(P0.05)。ROC曲線分析顯示,血漿miRNA-122a、miRNA-146a、miRNA-155a表達(dá)量診斷膿毒癥的ROC曲線下面積(AUC)分別為0.787[95%可信區(qū)間(95%CI)=0.703~0.872]、0.732(95%CI=0.629~0.835)和0.740(95%CI=0.635~0.844)。(2)與存活組比較,單因素分析顯示,28天死亡組疾病嚴(yán)重程度、序貫器官衰竭評分(sequential organ failure assessment,SOFA)、急性生理與慢性健康評分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、CRP(C-反應(yīng)蛋白)、PCT(降鈣素原)、Lac(乳酸)、miRNA-122a、miRNA-155a均明顯升高(P0.05),miRNA-146a表達(dá)量明顯降低(P0.05);而兩組間性別、年齡、WBC(白細(xì)胞計數(shù))差異均無統(tǒng)計學(xué)意義(P0.05)。二元logistic回歸多因素分析顯示,嚴(yán)重程度、SOFA評分、APACHEⅡ評分、miRNA-122a、miRNA-155a是影響預(yù)后的危險因素。結(jié)論:(1)血漿miRNA-122a、miRNA-146a、miRNA-155a可作為膿毒癥診斷標(biāo)志物。(2)血漿miRNA-122a、miRNA-146a、miRNA-155a對判斷膿毒癥嚴(yán)重程度存在指導(dǎo)意義(3)血漿miRNA-122a、miRNA-155a是膿毒癥的獨立危險因素,對膿毒癥的預(yù)后存在預(yù)警作用。
[Abstract]:Background and objective: although the treatment of sepsis has been greatly improved, it is still the leading cause of death in ICU and a serious threat to human health. So if you find a specific biomarker for the diagnosis of sepsis, it will improve the diagnosis and treatment of sepsis and improve the survival rate of patients. The aim of this study was to measure the expression of miRNA-122 aRNA-146asimiRNA-155a in plasma of septic patients to determine whether it can be used as a diagnostic marker for sepsis. Methods: 103 patients with sepsis were selected as subjects. There were 71 cases of sepsis group and 32 cases of septic shock group. 30 healthy persons were selected as control group. The expression of miRNA-122ahmiRNA-146a miRNA-155a in plasma was measured by real-time fluorescence quantitative analysis (RT-PCR). The diagnostic value of miRNA in sepsis was evaluated by using the operating characteristic curve of subjects. According to the outcome of 28 days, the patients were divided into survival group (n = 75) and death group (n = 28). Binary logistic regression was used. The risk factors influencing the prognosis of sepsis patients were analyzed. In septic group and septic shock group, the expression of miRNA-122 aRNA-155a in plasma increased in turn, while miRNA-146a decreased in turn (P 0.05). The results showed that the area under the ROC curve of plasma miRNA-122 aRNA-146aRNA-155a expression in septic diagnosis was 0.787 (95% confidence interval 95CI95CI95CI0.6290.0.835) and 0.740 ~ 95CI0.635 ~ (0.844)), respectively, compared with survival group. Univariate analysis showed the severity of the disease in the 28-day death group. Sequential organ failure assessment of SOFAA, acute physiology and chronic health evaluation 鈪，

本文編號：1622198