目的 通过检测血清microRNA变化,预判急性胰腺炎的病情严重度并探讨影响经皮置管引流(PCD)治疗的因素.方法 回顾性分析2013年10月至2014年3月成都军区总医院收治的120例急性胰腺炎患者的临床资料并采集其外周血,35例急性重度胰腺炎(SAP)、急性中重度胰腺炎(MSAP)为A组,85例急性轻度胰腺炎(MAP)为B组.对所有患者进行APACHE Ⅱ、Reason、BISAP评分,用实时定量PCR法进行定量检测患者血清中miR-146a、miR-10b、miR-21、miR-26a表达水平,比较两组之间的4种microRNA表达差异以及与评分系统间的相关性,并分析影响PCD治疗的因素.计量资料采用t检验,变量间关系采用直线相关分析.单因素和多因素分析采用Logistic回归.结果 (1)APACHEⅡ、RANSON、BISAP评分:A组分别为(8.28±0.61)分、(3.42±0.54)分、(1.71±0.32)分;B组分别为(3.18±0.52)分、(1.43±0.25)分、(0.37±0.06)分,两组比较,差异有统计学意义(t=4.266,7.809,4.113,P＜0.05).(2)血清miR-146a、miR-10b、miR-21、miR-26a表达水平:A组分别为1.41±0.21、2.94±0.49、1.62±0.25、1.21±0.20;B组分别为6.29±0.91、0.52±0.09、2.82±0.33、3.57±0.64.miR-146a、miR-10b在两组间差异有统计学意义(=-2.156,2.110,P＜0.05),而miR-21、miR-26a两组间差异无统计学意义(t=-1.114,-1.571,P ＞0.05).(3)相关性:A组miR-146a、miR-10b与APACHEⅡ、RANSON、BISAP评分有相关性(r=-0.826、0.837,-0.874、0.866,-0.833、0.899,P＜0.05).而miR-21、miR-26a表达水平与APACHE Ⅱ、RANSON、BISAP评分无相关性(r=0.642、0.321,0.701、0.750,0.716、0.716,P＞0.05).B组miR-146a、miR-10b、miR-21、miR-26a表达水平与APACHE Ⅱ评分无相关性(r=0.067,0.347,0.133,0.111,P＞0.05);与RANSON评分无相关性(r =0.178,0.078,0.092,0.142,P＞0.05);与BISAP评分无相关性(r=0.103,0.260,0.216,0.285,P＞0.05).(4)预测因素分析:单因素Logistic回归分析发现RANSON评分、BISAP评分、miR-10b是影响PCD干预的因素(OR =4.170,5.612,2.500;95％可信区间:1.092 ～ 15.932,1.232 ～21.622,1.190 ～5.254,P＜0.05).多因素Logistic回归分析发现miR-10b是急性胰腺炎PCD干预的独立影响因素(OR=2.374,95％可信区间:1.115 ～5.056,P＜0.05).结论 miR-10b与miR-146a可能成为判断急性重症胰腺炎严重程度的预测指标;miR-10b可能成为急性胰腺炎是否行PCD干预的判定指标.
目的 通過檢測血清microRNA變化,預判急性胰腺炎的病情嚴重度併探討影響經皮置管引流(PCD)治療的因素.方法 迴顧性分析2013年10月至2014年3月成都軍區總醫院收治的120例急性胰腺炎患者的臨床資料併採集其外週血,35例急性重度胰腺炎(SAP)、急性中重度胰腺炎(MSAP)為A組,85例急性輕度胰腺炎(MAP)為B組.對所有患者進行APACHE Ⅱ、Reason、BISAP評分,用實時定量PCR法進行定量檢測患者血清中miR-146a、miR-10b、miR-21、miR-26a錶達水平,比較兩組之間的4種microRNA錶達差異以及與評分繫統間的相關性,併分析影響PCD治療的因素.計量資料採用t檢驗,變量間關繫採用直線相關分析.單因素和多因素分析採用Logistic迴歸.結果 (1)APACHEⅡ、RANSON、BISAP評分:A組分彆為(8.28±0.61)分、(3.42±0.54)分、(1.71±0.32)分;B組分彆為(3.18±0.52)分、(1.43±0.25)分、(0.37±0.06)分,兩組比較,差異有統計學意義(t=4.266,7.809,4.113,P＜0.05).(2)血清miR-146a、miR-10b、miR-21、miR-26a錶達水平:A組分彆為1.41±0.21、2.94±0.49、1.62±0.25、1.21±0.20;B組分彆為6.29±0.91、0.52±0.09、2.82±0.33、3.57±0.64.miR-146a、miR-10b在兩組間差異有統計學意義(=-2.156,2.110,P＜0.05),而miR-21、miR-26a兩組間差異無統計學意義(t=-1.114,-1.571,P ＞0.05).(3)相關性:A組miR-146a、miR-10b與APACHEⅡ、RANSON、BISAP評分有相關性(r=-0.826、0.837,-0.874、0.866,-0.833、0.899,P＜0.05).而miR-21、miR-26a錶達水平與APACHE Ⅱ、RANSON、BISAP評分無相關性(r=0.642、0.321,0.701、0.750,0.716、0.716,P＞0.05).B組miR-146a、miR-10b、miR-21、miR-26a錶達水平與APACHE Ⅱ評分無相關性(r=0.067,0.347,0.133,0.111,P＞0.05);與RANSON評分無相關性(r =0.178,0.078,0.092,0.142,P＞0.05);與BISAP評分無相關性(r=0.103,0.260,0.216,0.285,P＞0.05).(4)預測因素分析:單因素Logistic迴歸分析髮現RANSON評分、BISAP評分、miR-10b是影響PCD榦預的因素(OR =4.170,5.612,2.500;95％可信區間:1.092 ～ 15.932,1.232 ～21.622,1.190 ～5.254,P＜0.05).多因素Logistic迴歸分析髮現miR-10b是急性胰腺炎PCD榦預的獨立影響因素(OR=2.374,95％可信區間:1.115 ～5.056,P＜0.05).結論 miR-10b與miR-146a可能成為判斷急性重癥胰腺炎嚴重程度的預測指標;miR-10b可能成為急性胰腺炎是否行PCD榦預的判定指標.
목적 통과검측혈청microRNA변화,예판급성이선염적병정엄중도병탐토영향경피치관인류(PCD)치료적인소.방법 회고성분석2013년10월지2014년3월성도군구총의원수치적120례급성이선염환자적림상자료병채집기외주혈,35례급성중도이선염(SAP)、급성중중도이선염(MSAP)위A조,85례급성경도이선염(MAP)위B조.대소유환자진행APACHE Ⅱ、Reason、BISAP평분,용실시정량PCR법진행정량검측환자혈청중miR-146a、miR-10b、miR-21、miR-26a표체수평,비교량조지간적4충microRNA표체차이이급여평분계통간적상관성,병분석영향PCD치료적인소.계량자료채용t검험,변량간관계채용직선상관분석.단인소화다인소분석채용Logistic회귀.결과 (1)APACHEⅡ、RANSON、BISAP평분:A조분별위(8.28±0.61)분、(3.42±0.54)분、(1.71±0.32)분;B조분별위(3.18±0.52)분、(1.43±0.25)분、(0.37±0.06)분,량조비교,차이유통계학의의(t=4.266,7.809,4.113,P＜0.05).(2)혈청miR-146a、miR-10b、miR-21、miR-26a표체수평:A조분별위1.41±0.21、2.94±0.49、1.62±0.25、1.21±0.20;B조분별위6.29±0.91、0.52±0.09、2.82±0.33、3.57±0.64.miR-146a、miR-10b재량조간차이유통계학의의(=-2.156,2.110,P＜0.05),이miR-21、miR-26a량조간차이무통계학의의(t=-1.114,-1.571,P ＞0.05).(3)상관성:A조miR-146a、miR-10b여APACHEⅡ、RANSON、BISAP평분유상관성(r=-0.826、0.837,-0.874、0.866,-0.833、0.899,P＜0.05).이miR-21、miR-26a표체수평여APACHE Ⅱ、RANSON、BISAP평분무상관성(r=0.642、0.321,0.701、0.750,0.716、0.716,P＞0.05).B조miR-146a、miR-10b、miR-21、miR-26a표체수평여APACHE Ⅱ평분무상관성(r=0.067,0.347,0.133,0.111,P＞0.05);여RANSON평분무상관성(r =0.178,0.078,0.092,0.142,P＞0.05);여BISAP평분무상관성(r=0.103,0.260,0.216,0.285,P＞0.05).(4)예측인소분석:단인소Logistic회귀분석발현RANSON평분、BISAP평분、miR-10b시영향PCD간예적인소(OR =4.170,5.612,2.500;95％가신구간:1.092 ～ 15.932,1.232 ～21.622,1.190 ～5.254,P＜0.05).다인소Logistic회귀분석발현miR-10b시급성이선염PCD간예적독립영향인소(OR=2.374,95％가신구간:1.115 ～5.056,P＜0.05).결론 miR-10b여miR-146a가능성위판단급성중증이선염엄중정도적예측지표;miR-10b가능성위급성이선염시부행PCD간예적판정지표.
Objective To predict the severity of acute pancreatitis by detecting the changes of microRNA in the serum,and whether paracentesis catheter drainage (PCD) should be applied to the patients.Methods The peripheral blood of 120 patients with acute pancreatitis who were admitted to the General Hospital of Chengdu Military Command from October 2013 to March 2014 were collected.Thirty-five patients with severe acute pancreatitis (SAP) or moderately severe acute pancreatitis (MSAP) were in the group A,and 85 patients with mild acute pancreatitis (MAP) were in the group B.The scores of the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),RANSON and bedside index for severity in acute pancreatitis (BISAP) were assessed.The expressions of the miR-146a,miR-10b,miR-21 and miR-26a in the serum were detected by the real-time quantitative PCR.The differences in the expressions of the 4 kinds of microRNAs in the 2 groups were compared,and the correlation between the 3 exaluation system was analyzed.Factors influencing the timing of the PCD for the PCD patients were analyzed.The measurement data were analyzed using the t test,and the relationship between the variables was analyzed using the linear correlation analysis or the rank correlation analysis.Univariate or multivariate analysis was done by the Logistic regression analysis.Results (1) The scores of the APACHE Ⅱ,RANSON and BISAP were 8.28 ±0.61,3.42 ±0.54 and 1.71 ±0.32 in the group A,and 3.18 ±0.52,1.43 ±0.25 and 0.37 ±0.06 in the group B,with significant differences between the 2 groups (t =4.266,7.809,4.113,P ＜ 0.05).(2) The expressions of the miR-146a,miR-10b,miR-21 and miR-26a were 1.41 ± 0.21,2.94 ± 0.49,1.62 ± 0.25,1.21 ± 0.20 in the group A,and 6.29 ± 0.91,0.52 ± 0.09,2.82 ± 0.33 and 3.57 ± 0.64 in the group B.There were significant differences in the expression of the miR-146a and miR-10b between the 2 groups (t＝-2.156,2.110,P ＜0.05),while no significant difference in the miR-21,miR-26a was detected between the 2 groups (t =-1.114,-1.571,P ＞ 0.05).(3) There was correlation between the expressions of the miR-146a,miR-10b and the APACHE Ⅱ,RANSON,BISAP in the group A (r =-0.826,0.837,-0.874,0.866,-0.833,0.899,P ＜ 0.05),while no correlation was detected between the expressions of the miR-21,miR-26a and the 3 exaluation systems in the group A (r =0.642,0.321,0.701,0.750,0.716,0.716,P ＞ 0.05).There was no significant difference between the miR-146a,miR-10b,miR-21,miR-26a and the APACHE Ⅱ (r =0.067,0.347,0.133,0.111,P＞0.05),RANSON (r=0.178,0.078,0.092,0.142,P ＞0.05) and BISAP (r =0.103,0.260,0.216,0.285,P ＞ 0.05) in the group B.(4) The results of univariate analysis showed that miR-10b,RANSON and BISAP were the factors influencing the timing of PCD (OR =4.170,5.612,2.500,95 ％ confidence interval:1.092-15.932,1.232-21.622,1.190-5.254,P ＜ 0.05).The results of multivariate analysis showed that miR-10b was the factor influencing the timing of PCD (OR =2.374,95％ confidence interval:1.115-5.056,P ＜ 0.05).Conclusions miR-10b and miR-146a might be the predictors of severity of severe acute pancreatitis; miR-10b might be the indicator in judging whether PCD should be applied.
