【摘要】 目的探讨血浆miR-30b-5p、血管外肺水指数（EVLWI）与急性呼吸窘迫综合征（ARDS）患者病情严重程度及预后的关系。方法选择172例ARDS患者,根据氧合指数（PaO₂/FiO₂）分为轻度组（PaO₂/FiO₂:201～300mmHg,53例）、中度组（PaO₂/FiO₂:101～200 mmHg,71例）、重度组（PaO₂/FiO₂:≤100 mmHg,48例）,根据住院28 d内死亡情况将其分为死亡组（64例）和存活组（108例）。采用RT-PCR法检测血浆miR-30b-5p表达,脉波指示剂连续心排出量监测（PiCCO）法检测EVLWI指数,Spearman秩相关分析miR-30b-5p、EVLWI与ARDS分级、急性生理学和慢性健康状况评分Ⅱ（APACHEⅡ）评分、顺序序贯器官衰竭评估（SOFA）评分间相关性,二元Logistic回归分析ARDS患者预后的相关影响因素。采用受试者工作特征（ROC）曲线分析miR-30b-5p、EVLWI预测ARDS患者预后的价值。结果重度组血浆miR-30b-5p表达、EVLWI指数高于中度组和轻度组（P均<0.05）,中度组血浆miR-30b-5p表达、EVLWI指数高于轻度组（P均<0.05）。死亡组SOFA评分、APACHEⅡ评分、血浆miR-30b-5p表达、EVLWI指数高于存活组（P均<0.05）,PaO₂/FiO₂低于存活组（P<0.05）。Spearman秩相关分析结果显示,ARDS患者血浆miR-30b-5p表达、EVLWI指数与APACHEⅡ评分、SOFA评分、ARDS分级均呈正相关（r分别为0.502、0.498、0.573,0.568、0.623、0.619,P均<0.05）。二元Logistic回归分析结果显示,高APACHEⅡ评分、高表达miR-30b-5p、高EVLWI指数是ARDS不良预后的危险因素（P均<0.01）。ROC曲线分析结果示,miR-30b-5p、EVLWI、miR-30b-5p+EVLWI预测ARDS患者预后的曲线下面积分别为0.738、0.824、0.913。结论 ARDS患者血浆miR-30b-5p、EVLWI与ARDS患者病情严重程度和预后有关,二者可作为预后评估的参考指标。更多还原

【Abstract】 Objective To investigate the relationship between plasma miR-30 b-5 P and EVLWI and the severity and prognosis of patients with acute respiratory distress syndrome（ARDS）.Methods Totally 172 ARDS patients were selected.According to the oxygenation index（PaO₂/FiO₂）,the patients were divided into the mild group（PaO₂/FiO₂:201-300 mmHg,53 cases）,moderate group（PaO₂/FiO₂:101-200 mmHg,71 cases）,and severe group（PaO₂/FiO₂:≤100 mmHg,48 cases）;according to the death within 28 days of hospitalization,the patients were divided into the death group（64 cases） and survival group（108 cases）.Plasma miR-30 b-5 p expression was detected by real-time quantitative reverse transcription-polymerase chain reaction（RT-PCR）.The EVLWI index was detected by Pulse Index Continuous Cardiac Output（PICCO） method.Spearman rank correlation analyzed the correlation between miR-b-5 p,EVLWI,ARDS grading,acute physiology and chronic health evaluation（APACHE） Ⅱ score,and sequential organ failure assessment（SOFA）score;binary Logistic regression analyzed the related factors for the prognosis of ARDS patients.The value of miR-30 b-5 P and EVLWI in predicting the prognosis of ARDS patients was analyzed by receiver operating characteristic（ROC） curve.Results The expression levels of plasma miR-30 b-5 P and EVLWI index in the severe group were higher than those in the moderate and mild groups（all P<0.05）,while the expression levels of plasma miR-30 b-5 p and EVLWI index in the moderate group were higher than those in the mild group（all P<0.05）.SOFA score,APACHE Ⅱ score,plasma miR-30 b-5 p,and EVLWI index were higher in the death group than in the survival group（all P<0.05）,and PaO₂/FiO₂ was lower than that of the survival group（P<0.05）.Spearman rank correlation analysis results showed that the plasma miR-30 b-5 p expression and EVLWI index were positively correlated with APACHE Ⅱ score,SOFA score,and ARDS grading（r=0.502,0.498,0.573,0.568,0.623,0.619,respectively;all P<0.05）.Binary Logistic regression analysis showed that high APACHE II score,high expression of miR-30 b-5 p,high EVLWI were risk factors for poor prognosis of ARDS patients（all P<0.01）.ROC analysis results showed that the area under curve（AUC） of miR-30 b-5 p,EVLWI,miR-30 b-5 p+EVLWI in predicting the prognosis of patients with ARDS were 0.738,0.824,and 0.913,respectively.Conclusion The expression of plasma miR-30 b-5 P and EVLWI increase in ARDS patients,and miR-30 b-5 p and EVLWI are closely related to the severity and prognosis of ARDS patients,which can be used as reference indexes for prognosis assessment.更多还原