标题：脓毒症并发急性肾损伤患儿血清中miR-93-5p和miR-424-5p的表达及临床意义

      作者：马静，郑喜胜，李长力，赵聪源    南阳市中心医院综合 ICU，河南 南阳 473000

      卷次： 2024年35卷4期

      【摘要】 目的 探讨血清中微小RNA-93-5p (miR-93-5p)和微小RNA-424-5p (miR-424-5p)在脓毒症并发急性肾损伤(S-AKI)患儿中的表达水平及其临床意义。方法 选取2019年11月至2021年11月南阳市中心医院综合ICU收治的116例脓毒症患儿作为研究对象，根据脓毒症患儿是否并发AKI分为AKI组60例和非AKI组56例；比较两组患儿的一般资料和血清miR-93-5p、miR-424-5p及肾功能指标[血肌酐(Scr)、胱抑素C (Cys-C)]水平；采用Pearson法分析S-AKI患儿血清miR-93-5p、miR-424-5p与肾功能指标的相关性；采用多因素Logistic回归分析脓毒症患儿并发AKI的影响因素；采用受试者工作特征曲线(ROC)分析血清miR-93-5p、miR-424-5p水平对脓毒症患儿并发AKI的诊断价值。结果 AKI组患儿的尿量为(1.52±0.31) mL·kg-1·h-1、血清miR-93-5p表达水平为 0.62±0.14，均明显低于非AKI组的(1.87±0.36) mL·kg-1·h-1、(1.02±0.21)，急性生理学与慢性健康状况评分(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分)、血清miR-424-5p表达水平、Scr、Cys-C水平分别为(17.35±5.01)分、(5.77±1.80)分、(2.36±0.51)、(182.84±43.31) μmol/L、(1.63±0.39) mg/L，明显高于非AKI组的(14.96±4.12)分、(5.10±1.41)分、(1.01±0.23)、(91.51±28.34) μmol/L、(0.96±0.28) mg/L，差异均有统计学意义(P<0.05)；经Pearson法分析结果显示，S-AKI患儿血清miR-93-5p与Scr、Cys-C呈负相关(r=-0.621、-0.720，P<0.05)，miR-424-5p与Scr、Cys-C呈正相关(r=0.503、0.538，P<0.05)；经多因素Logistic回归分析结果显示，miR-424-5p、Scr、Cys-C是影响脓毒症患儿并发AKI的危险因素，miR-93-5p是保护因素(P<0.05)；经ROC分析结果显示，血清miR-93-5p、miR-424-5p以及两者联合诊断脓毒血症患儿并发AKI的AUC分别为 0.856、0.860、0.949，联合诊断的敏感度为 90.00%，特异性为 91.07%，两者联合优于血清 miR-93-5p、miR-424-5p各自单独诊断 (Z 两者联合 -miR-93-5p=2.897、Z 两者联合 -miR-424-5p=2.706，P=0.004、P=0.007)。结论 S-AKI患儿血清miR-93-5p水平显著下调，miR-424-5p水平显著上调，两者联合诊断脓毒血症患儿并发AKI具有更高价值。
      【关键词】 脓毒症；急性肾损伤；微小RNA-93-5p；微小RNA-424-5p；临床意义
      【中图分类号】 R726.1 【文献标识码】 A 【文章编号】 1003—6350（2024）04—0531—06

Expression and clinical significance of miR-93-5p and miR-424-5p in serum of children with sepsis complicatedby acute kidney injury.
MA Jing, ZHENG Xi-sheng, LI Chang-li, ZHAO Cong-yuan. Comprehensive ICU, NanyangCentral Hospital, Nanyang 473000, Henan, CHINA
【Abstract】 Objective To investigate the expression and clinical significance of microRNA-93-5p(miR-93-5p) and microRNA-424-5p (miR-424-5p) in serum of children with sepsis complicated by acute kidney inju-ry (S-AKI). Methods A total of 116 children with sepsis admitted to Comprehensive ICU of Nanyang Central Hospitalfrom November 2019 to November 2021 were collected as the study subjects. The children were grouped into an AKIgroup of 60 cases and a non-AKI group of 56 cases based on whether they were complicated with AKI. The levels of se-rum miR-93-5p, miR-424-5p, and renal function indicators such as serum creatinine (Scr) and cystatin C (Cys-C) weredetected in both groups. Pearson method was applied to analyze the correlation between serum miR-93-5p,miR-424-5p and renal function indicators in children with S-AKI. Multivariate logistic regression was applied to ana-lyze the influencing factors of AKI in children with sepsis. ROC curve was applied to analyze the diagnostic value of serummiR-93-5p and miR-424-5p levels for sepsis complicated with AKI in children. Results The urine volume of children inAKI group was (1.52±0.31) mL·kg-1·h-1, and the expression level of serum miR-93-5p was 0.62±0.14, which were signifi-cantly lower than (1.87±0.36) mL·kg-1·h-1, 1.02±0.21 in non-AKI group (P<0.05). The Acute Physiology and ChronicHealth Evaluation (APACHE Ⅱ) score, sequential organ failure score (SOFA) score, serum miR-424-5p level, Scr level,and Cys-C level were (17.35±5.01) points, (5.77±1.80) points, 2.36±0.51, (182.84±43.31) μmol/L, (1.63±0.39) mg/L,significantly higher than (14.96±4.12) points, (5.10±1.41) points, 1.01±0.23, (91.51±28.34) μmol/L, (0.96±0.28) mg/L inthe non-AKI group (P<0.05). Serum miR-93-5p was negatively correlated with Scr and Cys-C in children with S-AKI(r=-0.621, -0.720, P<0.05), while miR-424-5p was positively correlated with Scr and Cys-C (r=0.503, 0.538, P<0.05).miR-424-5p, Scr, and Cys-C were risk factors for AKI in children with sepsis, while miR-93-5p was a protective factor(P<0.05). AUC of serum miR-93-5p, miR-424-5p, and their combination in diagnosing AKI in children with sepsis was0.856, 0.860, and 0.949, respectively; the sensitivity and specificity of the combined diagnosis were 90.00% and91.07%, respectively, which was superior to that of serum miR-93-5p and miR-424-5p alone (Zcombination-miR-93-5p=2.897,Zcombination-miR-424-5p=2.706; P=0.004, P=0.007). Conclusion Serum miR-93-5p is significantly down-regulated andmiR-424-5p is significantly up-regulated in children with S-AKI. The combination of the two has higher value in diag-nosing sepsis complicated with AKI than each index alone.
      【Key words】 Sepsis; Acute kidney injury; micro RNA-93-5p; micro RNA-424-5p; Clinical significance