脓毒症并发心肌损伤患者微小RNA-21-3p、微小RNA-210-5p与肌钙蛋白I相关并交互影响

张璐.脓毒症并发心肌损伤患者微小RNA-21-3p、微小RNA-210-5p与肌钙蛋白I相关并交互影响[J].内科急危重症杂志,2025,31(6):549-553

DOI：10.11768/nkjwzzzz20250613

中文关键词: 脓毒症心肌损伤微小RNA-21-3p 微小RNA-210-5p 肌钙蛋白I 相关性交互作用

英文关键词:

基金项目:

作者	单位	E-mail
张璐	泰州市第二人民医院	zhangluluxiaoer@163.com

摘要点击次数: 7

全文下载次数: 7

中文摘要:

摘要目的：探讨脓毒症并发心肌损伤患者微小RNA-21-3p（miR-21-3p）、微小RNA-210-5p（miR-210-5p）表达与肌钙蛋白I（cTnI）的关系及交互作用。方法：选取脓毒症患者128例，根据是否并发心肌损伤分为损伤组（41例）与未损伤组（87例）。比较2组临床资料、cTnI、miR-21-3p、miR-210-5p水平，分析miR-21-3p、miR-210-5p与cTnI的关系，评价miR-21-3p、miR-210-5p对脓毒症并发心肌损伤的预测价值，分析miR-21-3p与miR-210-5p的交互作用。结果：损伤组病情严重程度、急性生理与慢性健康状态评估（APACHE Ⅱ）评分、序贯器官衰竭评估（SOFA）评分、cTnI、miR-21-3p水平高于未损伤组，miR-210-5p水平低于未损伤组（P均＜0.05）；miR-21-3p与cTnI呈正相关，miR-210-5p与cTnI呈负相关（r=0.731、-0.719，P＜0.05）；校正病情严重程度、APACHE Ⅱ评分、SOFA评分等其他因素前、后，miR-21-3p、miR-210-5p与脓毒症并发心肌损伤独立相关（P均＜0.05）；受试者工作特征（ROC）曲线分析显示，miR-21-3p、miR-210-5p预测脓毒症并发心肌损伤的曲线下面积（AUC）为0.750（95%CI：0.666～0.823）、0.759（95%CI：0.676～0.830）；二者的最佳截断值为4.10、0.89，敏感度为82.93%、51.22%，特异性为59.77%、86.21%；二者联合预测AUC为0.916（95%CI：0.853～0.957），敏感度为90.24%，特异性为79.31%，显著优于二者单独预测（P＜0.05）；将miR-21-3p、miR-210-5p根据最佳截断值分为高表达与低表达。miR-21-3p高表达与miR-210-5p低表达在脓毒症并发心肌损伤呈正向交互作用（OR为28.600，γ为1.519，为次相乘模型）。结论：脓毒症并发心肌损伤患者miR-21-3p、miR-210-5p与cTnI显著相关且交互影响，二者联合检测有助于预测心肌损伤风险。

英文摘要:

Abstract Objective: To investigate the relationship and interaction between the expression of microRNA-21-3p (miR-21-3p), microRNA-210-5p (miR-210-5p) and cardiac troponin I (cTnI) in patients with sepsis complicated with myocardial injury. Methods: A total of 128 patients with sepsis were selected and divided into injury group (41 cases) and non-injury group (87 cases) according to whether they were complicated with myocardial injury. The clinical data, cTnI, miR-21-3p and miR-210-5p levels were compared between the two groups. The relationship between miR-21-3p, miR-210-5p and cTnI was analyzed. The predictive value of miR-21-3p and miR-210-5p for sepsis complicated with myocardial injury was evaluated. The interaction between miR-21-3p and miR-210-5p was analyzed. Results: The severity of the disease, acute physiology and chronic health evaluation (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, cTnI and miR-21-3p levels in the injury group were higher than those in the non-injury group, and the level of miR-210-5p was lower than that in the non-injury group (all P< 0.05). MiR-21-3p was positively correlated with cTnI, and miR-210-5p was negatively correlated with cTnI (r= 0.731, -0.719, P< 0.05). MiR-21-3p and miR-210-5p were independently associated with sepsis complicated with myocardial injury before and after adjusting for other factors such as severity of disease, APACHEⅡ score, SOFA score (all P< 0.05). The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of miR-21-3p and miR-210-5p in predicting sepsis complicated with myocardial injury was 0.750 (95%CI: 0.666-0.823) and 0.759 (95%CI: 0.676-0.830), the optimal cut-off values of the two were 4.10 and 0.89, the sensitivity was 82.93% and 51.22%, and the specificity was 59.77% and 86.21%, respectively. The AUC of the combined prediction of the two was 0.916 (95%CI: 0.853-0.957), the sensitivity was 90.24%, and the specificity was 79.31%, which was significantly better than the prediction of the two alone (P< 0.05). According to the optimal cut-off value, miR-21-3p and miR-210-5p were divided into high expression and low expression. There was a positive interaction between high expression of miR-21-3p and low expression of miR-210-5p in sepsis complicated with myocardial injury (OR= 28.600, γ= 1.519, sub-multiplication model). Conclusion: miR-21-3p, miR-210-5p and cTnI are significantly correlated and interacted in patients with sepsis complicated with myocardial injury. The combined detection of miR-21-3p and miR-210-5p is helpful to predict the risk of myocardial injury.