Abstract:

Objective　This study aimed to assess the serum levels of miR-16-5p and miR-155-5p in patients with infectious shock, and to explore their relationships with prognosis. Methods　From June 2021 to July 2023, a total of 86 patients diagnosed with infectious shock were selected from the Emergency Department of Chang'an Hospital. There were 47 males and 39 females, 45 cases <60 years old and 41 cases ≥60 years old. These patients were categorized into three groups based on the severity of their condition: mild (30 patients), moderate (29 patients), and severe degree (27 patients). Over a one-month period, the survival status of these patients was monitored, leading to the formation of two groups: a death group (20 patients) and a survival group (66 patients). Comparative analyses of clinical data were conducted across each group. The correlations between the expression levels of miR-16-5p and miR-155-5p and the Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score were analyzed. The receiver operating characteristic curve (ROC) was constructed to assess the prognostic diagnostic values of serum miR-16-5p and miR-155-5p in infectious shock. The risk factors of poor prognosis in patients with infectious shock were analyzed by logistic regression analysis. Independent sample t test, F test, χ² test, and Pearson correlation analysis were used. Results　The heart rate (HR), C-reactive protein (CRP), APACHEⅡ score, and expression levels of miR-16-5p and miR-155-5p in the severe group were higher than those in the mild and moderate groups (all P<0.05), but the mean arterial pressure (MAP), central venous pressure (CVP), and oxygenation index (OI) were lower than those in the mild and moderate groups (all P<0.05). The CRP, APACHEⅡ score, and expression levels of miR-16-5p and miR-155-5p in the death group were higher than those in the survival group (all P<0.05), but the OI was lower than that in the survival group (P<0.05). Pearson correlation analysis showed that the expression levels of miR-16-5p and miR-155-5p were positively correlated with APACHEⅡ score (r=0.509 and 0.722, both P<0.001). The area under the curve (AUC) of serum miR-16-5p combined with miR-155-5p in predicting poor prognosis in patients with infectious shock was 0.944, the 95% confidence interval (CI) was 0.894 - 0.994, the sensitivity was 90.0%, and the specificity was 84.8%, indicating high predictive efficacy. Both miR-16-5p and miR-155-5p were risk factors for poor prognosis in patients with infectious shock [OR=10.608 (2.275-49.461) and 25.410 (4.573-141.176), both P<0.05]. Conclusion　In patients with infectious shock, serum expression levels of miR-16-5p and miR-155-5p are significantly associated with the condition's severity and prognosis. Thus, these two miRNAs may serve as biomarkers for predicting poor prognosis in such patients.

Key words:

Infectious shock, miR-16-5p, miR-155-5p, Prognosis, Correlation

摘要：

目的　本研究旨在评估感染性休克患者血清miR-16-5p和miR-155-5p表达水平及其与预后的关系。方法　选取2021年6月至2023年7月长安医院急诊科收治的86例确诊为感染性休克的患者（男47例，女39例，<60岁45例，≥60岁41例），根据病情程度分为轻度组30例、中度组29例、重度组27例。对患者进行为期1个月的生存状况统计，基于生存情况将患者划分为死亡组20例和生存组66例。对比各组患者的临床资料，分析miR-16-5p和miR-155-5p表达水平与急性生理学和慢性健康状况评价（APACHEⅡ）评分的相关性，构建受试者操作特征曲线（ROC）分析血清miR-16-5p和miR-155-5p预测感染性休克患者预后的价值，logistic回归分析感染性休克患者预后不良的危险因素。采用独立样本t检验、F检验、χ²检验、Pearson相关性分析。结果　重度组的心率（HR）、C反应蛋白（CRP）、APACHEⅡ评分、miR-16-5p和miR-155-5p表达水平均高于轻度组和中度组（均P<0.05），平均动脉压（MAP）、中心静脉压（CVP）、氧合指数（OI）均低于轻度组和中度组（均P<0.05）。死亡组的CRP、APACHEⅡ评分、miR-16-5p和miR-155-5p表达水平均高于生存组（均P<0.05），OI低于生存组（P<0.05）。Pearson相关性分析显示miR-16-5p和miR-155-5p表达水平与APACHEⅡ评分均呈正相关（r=0.509、0.722，均P<0.001）。血清miR-16-5p联合miR-155-5p预测感染性休克患者预后不良的曲线下面积（AUC）为0.944，95%置信区间（CI）为0.894～0.994，灵敏度为90.0%，特异度为84.8%，显示出较高的预测效能。miR-16-5p和miR-155-5p均为感染性休克患者预后不良的危险因素［OR=10.608（2.275～49.461）、25.410（4.573～141.176），均P<0.05］。结论　在感染性休克患者中，血清miR-16-5p和miR-155-5p表达水平与病情严重程度和预后显著相关，这两种miRNA可作为感染性休克患者预后不良的生物标志物。

关键词:

感染性休克, miR-16-5p, miR-155-5p, 预后, 相关性