【摘要】：目的:探討miR-146a在膿毒癥診斷、病情評(píng)估及預(yù)后判斷中的作用。方法:2016年2月至2017年1月在新疆某三甲醫(yī)院收集54例膿毒癥患者,按病情分為膿毒癥組(33例)和感染性休克組(21例)。取同期健康體檢者30例作為對(duì)照組。膿毒癥患者按治療前(D0)及治療后1天(D1)、2天(D2)、3天(D3)、7天(D7)采集患者全血,檢測(cè)血漿miR-146a表達(dá)水平,及血清炎癥因子IL-1、IL-6、IL-10、PCT、CRP水平,并進(jìn)行APACHEⅡ評(píng)分、SOFA評(píng)分。對(duì)照組檢測(cè)入組時(shí)血漿miR-146a表達(dá)水平及血清IL-1、IL-6、IL-10、PCT、CRP水平。觀察各指標(biāo)變化趨勢(shì);分析miR-146a與IL-1、IL-6、IL-10、PCT、CRP及危重癥評(píng)分之間的相關(guān)性;明確miR-146a對(duì)膿毒癥診斷及預(yù)后的價(jià)值。結(jié)果:(1)膿毒癥患者miR-146a、CRP隨時(shí)間呈先升后降趨勢(shì),CRP于D1達(dá)高峰,miR-146a于D2達(dá)高峰;余指標(biāo)呈下降趨勢(shì)。(2)膿毒癥患者miR-146a、IL-6、PCT、CRP表達(dá)水平在D0-D7均高于健康人;IL-1水平在D0-D3高于健康人;IL-10水平在D0、D1高于健康,D7低于健康人(P㩳0.05);余時(shí)間點(diǎn)兩組間無(wú)差異(P㧐0.05)。(3)各指標(biāo)診斷膿毒癥AUC比較,PCT㧐miR-146a㧐CRP㧐IL-1㧐IL-6㧐IL-10。miR-146a的AUC為0.92(95%CI,0.87-0.98),cut-off值為14.25,敏感度、特異性分別為81.5%、90%。(4)感染性休克組miR-146a、IL-1、IL-6、PCT、CRP水平以及APACHEⅡ評(píng)分、SOFA評(píng)分在D0-D7均高于膿毒癥組,感染性休克組IL-10水平在D0-D2高于膿毒癥組,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.01);余時(shí)間點(diǎn)兩組間無(wú)差異(P㧐0.05)。(5)D0時(shí)miR-146a表達(dá)水平與SOFA評(píng)分呈正相關(guān),與APACHEⅡ評(píng)分無(wú)明顯相關(guān)性。(6)死亡組IL-1、PCT、APACHEⅡ評(píng)分、SOFA評(píng)分水平D0-D7均高于生存組;CRP水平D0-D2高于生存組,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05);余時(shí)間點(diǎn)兩組間無(wú)差異(P㧐0.05);miR-146a、IL-6、IL-10水平在D0-D7兩組間均無(wú)明顯差異(P㧐0.05);(7)各指標(biāo)預(yù)測(cè)膿毒癥病死率的AUC比較,SOFA㧐PCT㧐APACHEⅡ㧐IL-1㧐CRP㧐IL-10㧐IL-6㧐miR-146a。miR-146a的AUC為0.539(95%CI,0.366-0.711)。結(jié)論:1.miR-146a在膿毒癥的診斷中具有較高的價(jià)值,可能是膿毒癥診斷的生物標(biāo)志物。2.miR-146a對(duì)膿毒癥預(yù)后判斷價(jià)值較低。3.miR-146a表達(dá)水平可能與膿毒癥病情嚴(yán)重程度有關(guān)。
[Abstract]:Objective: to investigate the role of miR-146a in the diagnosis, evaluation and prognosis of sepsis. Methods: from February 2016 to January 2017, 54 patients with sepsis were collected from a third Class A Hospital in Xinjiang. According to their condition, they were divided into sepsis group (33 cases) and septic shock group (21 cases). 30 healthy persons were taken as control group. Whole blood samples were collected from patients with sepsis before and after treatment (D1), 2 days (D2), 3 days (D3), 7 days (D7). The expression of plasma miR-146a and serum inflammatory factor IL-1,IL-6,IL-10, were detected. PCT,CRP level, and APACHE 鈪，

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