脓毒症急性肾损伤患者血清miR-146a USF2 sCD74水平与病情严重程度的相关性及对预后的影响

doi:10.3969/j.issn.1006-6233.2025.07.018

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摘要 目的: 探讨脓毒症急性肾损伤(AKI)患者血清微小核糖核酸-146a(miR-146a)、上游刺激因子2(USF2)、可溶性CD74(sCD74)水平与病情严重程度的相关性及对预后的影响。方法: 选取秦皇岛市第一医院2022年1月至2024年1月脓毒症AKI患者144例,根据28d预后分为预后良好组与预后不良组,比较两组临床资料、血清miR-146a、USF2、sCD74水平,采用Spearman相关系数分析血清miR-146a、USF2、sCD74与脓毒症严重程度、AKI严重程度的相关性,偏相关性分析血清miR-146a、USF2、sCD74与预后的关系,受试者工作特征(ROC)曲线评价各指标对预后的预测价值。结果: 预后不良组脓毒症严重程度、AKI严重程度、APACHEⅡ、SOFA评分高于预后良好组(P<0.05);预后不良组血清miR-146a、USF2、sCD74水平高于预后良好组(P<0.05);脓毒症休克患者血清miR-146a、USF2、sCD74水平高于脓毒症患者(P<0.05);重度AKI患者血清miR-146a、USF2、sCD74水平高于轻度AKI患者(P<0.05);血清miR-146a、USF2、sCD74与脓毒症严重程度、AKI严重程度均呈正相关(P<0.05);偏相关性分析,血清miR-146a、USF2、sCD74与预后显著相关(P<0.05);ROC曲线分析,血清miR-146a、USF2、sCD74预测脓毒症AKI患者预后的AUC为0.776、0.751、0.780,Youden指数为0.438、0.406、0.479,敏感度为64.58%、64.58%、70.83%,特异度为79.17%、76.04%、77.08%;血清miR-146a、USF2、sCD74联合预测脓毒症AKI患者预后的AUC为0.922,Youden指数为0.771,敏感度为89.58%,特异度为87.50%,较各指标单独预测价值显著提高(Z=3.741、4.120、3.192,P均<0.001)。结论: 脓毒症AKI患者血清miR-146a、USF2、sCD74水平与脓毒症和AKI严重程度显著相关,是预后的独立预测因子,联合检测时能提高预测价值。

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	张梅香
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关键词 ：脓毒症, 急性肾损伤, 微小核糖核酸-146a, 上游刺激因子2, 可溶性CD74

Abstract：Objective: To investigate the correlation between the levels of serum microRNA-146a (miR-146a), upstream stimulatory factor 2 (USF2), and soluble CD74 (sCD74) and the severity of disease in patients with sepsis-associated acute kidney injury (AKI), as well as their impact on prognosis. Methods: A total of 144 patients with sepsis-induced AKI from January 2022 to January 2024 in Qinhuangdao First Hospital were selected. Based on the 28-day prognosis, patients were categorized into the good prognosis group and the poor prognosis group. The clinical data, serum levels of miR-146a, USF2, and sCD74 were compared between the two groups. The Spearman correlation coefficient was used to analyze the correlation between serum miR-146a, USF2, and sCD74 and the severity of sepsis and AKI. The relationship between serum miR-146a, USF2, and sCD74 and prognosis was analyzed using partial correlation analysis. Receiver operating characteristic (ROC) curves were evaluated for the predictive value of each indicator for prognosis. Results: Severity of sepsis, severity of AKI, APACHE II, and SOFA scores in the poor prognosis group were higher than in the good prognosis group (P<0.05). The levels of serum miR-146a, USF2, and sCD74 in the poor prognosis group were higher than in the good prognosis group (P<0.05). The levels of serum miR-146a, USF2, and sCD74 in patients with sepsis shock were higher than those in patients with sepsis (P<0.05). The levels of serum miR-146a, USF2, and sCD74 in patients with severe AKI were higher than in patients with mild AKI (P<0.05). Serum miR-146a, USF2, and sCD74 were positively correlated with sepsis severity and AKI severity (P<0.05). Partial correlation analysis showed serum miR-146a, USF2, and sCD74 were significantly correlated with prognosis (P<0.05). ROC curve analysis showed that the AUC of serum miR-146a, USF2, and sCD74 for predicting the prognosis of patients with sepsis-induced AKI were 0.776, 0.751, and 0.780, respectively, with Youden indexes of 0.438, 0.406, and 0.479, and sensitivities of 64.58%, 64.58%, and 70.83%, respectively. The specificities were 79.17%, 76.04%, and 77.08%, respectively. The AUC of serum miR-146a, USF2, and sCD74 combined to predict the prognosis of patients with sepsis-induced AKI was 0.922, with a Youden index of 0.771, a sensitivity of 89.58%, and a specificity of 87.50%. This significantly improved the predictive value compared to each indicator alone (Z=3.741, 4.120, 3.192, all P<0.001). Conclusion: The levels of serum miR-146a, USF2, and sCD74 in patients with sepsis and AKI are significantly correlated with the severity of sepsis and AKI, and are independent predictors of prognosis, and the predictive value can be enhanced when combined with other tests.

Key words： Sepsis Acute kidney injury Microribonucleic acid-146a Upstream stimulating factor 2 Soluble CD74

基金资助:河北省重点研发计划项目,(编号:22010010819D)

通讯作者: 刘秀娟

引用本文:

张梅香, 左志刚, 刘秀娟. 脓毒症急性肾损伤患者血清miR-146a USF2 sCD74水平与病情严重程度的相关性及对预后的影响[J]. 河北医学, 2025, 31(7): 1158-1164.
ZHANG Meixiang, ZUO Zhigang, LIU Xiujuan. The Correlation between the Levels of Serum miR-146a USF2 and sCD74 and the Severity of the Disease in Patients with Sepsis-Induced Acute Kidney Injury and the Impact on Prognosis. HeBei Med, 2025, 31(7): 1158-1164.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.07.018 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I7/1158

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