·
1469
·
中华危重病急救医学 2019 年 12 月第 31 卷第 12 期 Chin Crit Care Med,December 2019,Vol.31,No.12
·论著·
血清 miR
-
494 表达水平预测心脏术后
AKI 患儿的预后价值
吴日暖 吴用 杨丽霞 邓颖云 陈东旭
三亚市人民医院儿科 572000
通信作者
:
吴日暖
,
Email
:
w13617570966@163.com
【
摘要
】
目的 探讨血清微小 RNA
-
494(miR
-
494)表达水平对心脏术后急性肾损伤(AKI)患儿的预后预
测价值。方法 选择 2016 年 1 月至 2019 年 3 月三亚市人民医院收治的 116 例先天性心脏病(先心病)体外循
环手术后并发 AKI 的患儿。所有患儿均于术后采用实时荧光定量聚合酶链反应(RT
-
qPCR)检测血清 miR
-
494
表达,用酶联免疫吸附试验(ELISA)检测血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及肾损伤分子
-
1
(KIM
-
1)水平。根据 28 d 预后将患儿分为存活组和死亡组,比较两组患儿一般资料及血清 miR
-
494、NGAL、
KIM
-
1 水平。采用多因素 Logistic 回归分析心脏术后 AKI 患儿死亡的危险因素 ;受试者工作特征曲线(ROC)
分析血清 miR
-
494、NGAL 及 KIM
-
1 水平预测心脏术后 AKI 患儿预后的价值;Pearson 相关性分析血清 miR
-
494
表达水平与 NGAL、KIM
-
1 的相关性。结果 116 例先心病体外循环手术后并发 AKI 患儿 28 d 死亡 27 例,存
活 89 例。与存活组比较,死亡组患儿紫绀比例显著升高,血液灌流比例显著下降,体外循环时间、术后机械通
气时间明显延长,术后血糖水平明显升高,其他一般资料差异无统计学意义。死亡组血清 miR
-
494、NGAL 及
KIM
-
1 水平均明显高于存活组〔miR
-
494(2
-ΔΔCt
):3.75±1.28 比 1.48±0.71,NGAL(mg/L):583.60±52.72 比
320.52±31.84,KIM
-
1(μg/L):30.53±6.38 比 17.40±3.72,均 P<0.01〕。多因素 Logistic 回归分析显示,紫绀
〔优势比(OR)=1.716,95% 可信区间(95%CI)为 1.184~2.982,P=0.039〕、术后血糖(OR=1.925,95%CI 为
1.262~3.387,P=0.005)、血 清 miR
-
494(OR=2.527,95%CI 为 1.706~5.148,P<0.001)、NGAL(OR=2.473,
95%CI 为 1.620~4.935,P<0.001)及 KIM
-
1(OR=1.805,95%CI 为 1.213~3.106,P<0.001)升高是心脏术后
AKI 患儿死亡的独立危险因素。ROC 曲线分析显示,血清 miR
-
494、NGAL 及 KIM
-
1 均可预测心脏术后 AKI 患
儿死亡,ROC 曲线下面积(AUC)分别为 0.868、0.857、0.819;三者联合预测心脏术后 AKI 患儿死亡的 AUC 最大,
为 0.964(95%CI 为 0.908~0.997),其敏感度为 97.0%,特异度为 91.8%。相关性分析显示,死亡组血清 miR
-
494
表达水平与 NGAL、KIM
-
1 均呈显著正相关(r
1
=0.902、r
2
=0.873,均 P<0.01)。结论 血清 miR
-
494 表达水
平在心脏术后 AKI 患儿中明显升高,是心脏术后 AKI 患儿死亡的独立危险因素 ;血清 miR
-
494 联合 NGAL、
KIM
-
1 水平对患儿预后具有较高的预测价值。
【
关键词
】
急性肾损伤; 心脏手术; 儿童; 微小 RNA
-
494; 预后预测
基金项目 :海南省医药卫生科研基金项目(17A200826)
DOI:10.3760/cma.j.issn.2095-4352.2019.12.007
Value of serum level of microRNA
-
494 in predicting prognosis of acute renal injury after cardiac surgery in
children
Wu Rinuan, Wu Yong, Yang Lixia, Deng Yingyun, Chen Dongxu
Department of Pediatrics, Sanya People
'
s Hospital, Sanya 572000, Hainan, China
Corresponding author: Wu Rinuan, Email: w13617570966@163.com
【
Abstract
】
Objective To explore the value of serum microRNA
-
494 (miR
-
494) expression in predicting
the prognosis of acute renal injury (AKI) after cardiac surgery in children. Methods 116 children with AKI
after cardiopulmonary bypass for congenital heart disease admitted to Sanya People's Hospital from January 2016 to
March 2019 were enrolled. The expression of miR
-
494 in serum was detected by real
-
time fluorescence quantitative
polymerase chain reaction (RT
-
qPCR), and the levels of serum neutrophil gelatinase
-
associated lipocalin (NGAL) and
kidney injury molecule
-
1 (KIM
-
1) were detected by enzyme
linked immunosorbent assay (ELISA) of all the children.
The children were divided into survival group and death group according to 28
-
day survival. Serum levels of miR
-
494,
NGAL and KIM
-
1 were measured in two groups. Multivariate Logistic regression was used to analyze the risk factors of
death in children with AKI after cardiac surgery. The receiver operating characteristic (ROC) curve analysis of serum
levels of miR
-
494, NGAL and KIM
-
1 in predicting prognosis of children with AKI after cardiac surgery was performed.
Pearson correlation analysis was used to analyze the correlation between serum levels of miR
-
494 and NGAL, KIM
-
1.
Results After cardiopulmonary bypass in 116 children with AKI, 27 cases died and 89 cases survived during the
28
-
day observation. Compared with the survival group, the proportion of cyanosis in the death group was significantly
increased, the proportion of blood perfusion was significantly decreased, the time of cardiopulmonary bypass and
postoperative mechanical ventilation were significantly prolonged, and the blood glucose level was significantly increased