Correlation between the expressions of serum microRNA-29c-3p, microRNA-378a-3p and serum inflammatory factors, myocardial injury indexes and echocardiographic indexes in sepsis patients with myocardial injury and the value of prognosis evaluation / 中国医师进修杂志

ABSTRACT

Objective:To investigate the correlation between the expressions of microRNA (miR)-29c-3p, miR-378a-3p and serum inflammatory factors, myocardial injury indexes and echocardiographic indexes in sepsis patients with myocardial injury, and analyze the value of prognosis evaluation.Methods:Prospective research methods were used. Two hundred and eighty-six patients with sepsis in Handan Central Hospital from February 2019 to October 2021 were selected. The serum levels of miR-29c-3p and miR-378a-3p were detected by polymerase chain reaction, and serum Troponin I (TnI), creatine kinase isoenzyme MB (CK-MB), myoglobin (Mb), B-type brain natriuretic peptide (BNP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β) and procalcitonin (PCT) were detected. The left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), stroke output (SV), cardiac output (CO) and the ratio of early diastolic maximum mitral valve velocity to atrial systolic maximum velocity (E/A) were measured by echocardiography. Serum TnI≥0.15 μg/L was defined as myocardial injury, the survival status within 28 d of hospitalization in patients with myocardial injury was recorded, and the acute physiology and chronic health Ⅱ evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were evaluated. Pearson method was used for correlation analysis; Multivariate Logistic regression was used to analyze the independent risk factors of death within 28 d of hospitalization in sepsis patients with myocardial injury; the receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of miR-29c-3p and miR-378a-3p in predicting the death within 28 d of hospitalization in septic patents with myocardial injury patients.Results:Among 286 patients with sepsis, 131 had myocardial injury (myocardial injury group), and 155 had no myocardial injury (non-myocardial injury group). The miR-29c-3p, Mb, CK-MB, BNP, TnI, TNF-α, IL-6, IL-1β, PCT, CRP, LVEDD and LVESD in myocardial injury group were significantly higher than those in non-myocardial injury group 5.02 ± 1.69 vs. 2.01 ± 0.57, (102.35 ± 23.56) μg/L vs. (32.15 ± 9.12) μg/L, (25.01 ± 6.09) U/L vs. (13.02 ± 4.16) U/L, (905.23 ± 135.49) ng/L vs. (92.31 ± 26.35) ng/L, (0.23 ± 0.05) μg/L vs. (0.12 ± 0.02) μg/L, (13.41 ± 3.71) μg/L vs. (3.26 ± 0.95) μg/L, (9.02 ± 2.46) ng/L vs. (4.18 ± 1.03) ng/L, (71.45 ± 15.29) ng/L vs. (30.02 ± 6.39) ng/L, (1.05 ± 0.21) μg/L vs. (0.72 ± 0.13) μg/L, (21.35 ± 6.13) mg/L vs. (16.23 ± 4.57) mg/L, (37.45 ± 3.39) mm vs. (34.01 ± 2.15) mm and (50.12 ± 3.49) mm vs. (44.17 ± 3.02) mm, the miR-378a-3p, LVEF, SV, CO and E/A were significantly lower than those in non-myocardial injury group 1.67 ± 0.36 vs. 3.02 ± 0.79, (46.32 ± 3.26)% vs. (56.24 ± 4.98)%, (48.21 ± 2.81) ml vs. (56.02 ± 3.49) ml, (3.11 ± 0.29) L/min vs. (4.15 ± 0.31) L/min and 0.98 ± 0.21 vs. 1.19 ± 0.32, and there were statistical differences ( P<0.01). Pearson correlation analysis result showed that miR-29c-3p was positive correlation with TNF-α, IL-6, IL-1β, PCT, CRP, Mb, CK-MB, BNP, TnI, LVEDD and LVESD in sepsis patients with myocardial injury ( P<0.01 or <0.05), and it was negative correlation with LVEF, SV, CO and E/A ( P<0.01); miR-378a-3p was negative correlation with TNF-α, IL-6, IL-1β, PCT, CRP, Mb, CK-MB, BNP, TnI, LVEDD and LVESD ( P<0.01 or <0.05), and it was positive correlation with LVEF, SV, CO and E/A P<0.01). Among 131 sepsis patients with myocardial injury, 55 patients died within 28 d of hospitalization (death subgroup), and 76 patients survived (survival subgroup). The mechanical ventilation rate, continuous renal replacement therapy rate, APACHE Ⅱ, SOFA, miR-29c-3p, Mb, CK-MB, TnI, BNP, TNF-α, IL-6, IL-1β, PCT, CRP, LVEDD and LVESD in death subgroup were significantly higher than those in survival subgroup, the miR-378a-3p, LVEF, SV, CO and E/A were significantly lower than those in survival subgroup, and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that APACHE Ⅱ, TnI, miR-29c-3p were independent risk factors for death within 28 d of hospitalization in sepsis patients with myocardial injury ( OR = 1.203, 2.451 and 1.394; 95% CI 1.085 to 1.334, 1.498 to 4.008 and 1.141 to 1.702; P<0.01); and the miR-378a-3p an independent protective factor for death within 28 d of hospitalization in sepsis patients with myocardial injury ( OR = 0.367, 95% CI 0.217 to 0.622, P<0.01). ROC curve analysis result show that the best cut-off values of miR-29c-3p and miR-378a-3p for predicting the death within 28 d of hospitalization in sepsis patients with myocardial injury were 5.00 and 1.65; the area under the curve of miR-29c-3p combined with miR-378a-3p for predicting the death within 28 d of hospitalization in septic patients with myocardial injury was significantly larger than that of the two separate applications (0.890 vs. 0.695 and 0.732), with a sensitivity of 87.0%, a specificity of 87.3%, and an accuracy of 86.8%. Conclusions:The expression of serum miR-29c-3p is increased and the expression of miR-378a-3p is decreased in sepsis patients with myocardial injury. The expressions of miR-29c-3p and miR-378a-3p are related to the degree of myocardial injury, echocardiogram indexes, the levels of inflammatory factors and prognosis. The miR-29c-3p and miR-378a-3p can be used as potential prognostic indexes for sepsis patients with myocardial injury.