摘要
目的 探讨血清中微RNA(miR)-21-3p和白细胞介素(IL)-18水平对重症急性胰腺炎患者急性肾损伤(AKI)预测评估的临床价值.方法 前瞻性选取2020年9月至2023年青岛市中医医院收治的146例急性重症胰腺炎患者,根据有无AKI分为AKI组(n=51)和非AKI组(n=95).比较两组的临床资料[性别、年龄(≤50岁、＞50岁)、病因类型(酒精性、胆源性、高血脂性、其他)、体重指数(≤28 kg/m2、＞28 kg/m2)],比较两组血清中miR-21-3p(相对表达量、高表达比例、低表达比例)、IL-18水平(平均表达量、≤ 140 pg/mL比例、＞140 pg/mL比例);采用Logis-tic 回归模型分析影响重症急性胰腺炎患者住院期间AKI发生的因素;采用受试者操作特征(ROC)曲线分析miR-21-3p、IL-18对重症急性胰腺炎患者并发AKI的预测价值.结果 AKI组患者的性别、年龄、病因类型、体重指数与非AKI组比较,差异均无统计学意义(P＞0.05).AKI组的miR-21-3p相对表达量、IL-18水平、Ranson评分分别为2.24±0.52、(178.21±49.32)pg/mL、(6.14±1.24)分,均明显高于非 AKI 组[1.58±0.35、(82.35±38.43)pg/mL、(4.53±1.12)分],差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,miR-21-3p和IL-18增高均是SAP患者发生 AKI 的危险因素(OR=1.490,95％CI:1.035～1.832;OR=1.421,95％CI:1.042～1.734;P＜0.05).miR-21-3p和IL-18联合检测对重症急性胰腺炎伴AKI的诊断具有更高的敏感性和特异性,AUC为0.873,敏感度为90.42％,特异度为91.24％.结论 在重症急性胰腺炎合并AKI患者中,血清中miR-21-3p和IL-18水平显著升高.检测血清miR-21-3p和IL-18水平有助于预测重症急性胰腺炎合并AKI,尤其在联合检测时,有更高的准确性.
Abstract
Objective To investigate the clinical value of serum microRNA(miR)-21-3p and interleukin(IL)-18 levels in the pre-diction and evaluation of acute kidney injury(AKI)in patients with severe acute pancreatitis.Methods A total of 146 patients with severe acute pancreatitis admitted to Qingdao Hospital of Traditional Chinese Medicine from September 2020 to 2023 were prospectively selected,divided into the AKI group(n=51)and the non-AKI group(n=95)according to whether they had AKI or not.The clinical data[gender,age(≤50 years,＞50 years),etiology type(alcoholic,biliary,hyperlipidemic,other),body mass index(≤28 kg/m2,＞28 kg/m2)],the serum miR-21-3p(relative expression,high expression ratio,low expression ratio)and IL-18 levels(average expression,≤140 pg/mL ratio,＞140 pg/mL ratio)of the two groups were compared.The factors affecting the occurrence of AKI during hospitalization in patients with severe acute pancrea-titis were analyzed using a Logistic regression model.The predictive value of miR-21-3p and IL-18 for AKI in patients with severe acute pan-creatitis was analyzed using receiver operating characteristic(ROC)curves.Results There were no statistically significant differences in gender,age,etiology,and body mass index between the AKI group and the non-AKI group(P＞0.05);the relative expression of miR-21-3p,IL-18 level and Ranson score in the AKI group were 2.24±0.52,(178.21±49.32)pg/mL and(6.14±1.24)points,respectively,which were significantly higher than those in the non-AKI group[1.58±0.35,(82.35±38.43)pg/mL and(4.53±1.12)points],the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that increased miR-21-3 p and IL-18 were risk fac-tors for AKI in severe acute pancreatitis patients(OR=1.490,95％CI:1.035-1.832;OR=1.421,95％CI:1.042-1.734;P＜0.05).Combined detection of miR-21-3p and IL-18 had higher sensitivity and specificity for the diagnosis of severe acute pancreatitis with AKI,with an AUC of 0.873,a sensitivity of 90.42％,and a specificity of 91.24％.Conclusion In patients with severe acute pancreatitis complicated with AKI,serum levels of miR-21-3p and IL-18 are significantly increased.Detection of serum miR-21-3p and IL-18 levels is helpful to pre-dict severe acute pancreatitis complicated with AKI,especially when combined detection has higher accuracy.
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