血清microRNA-506、microRNA-146a对急性淋巴细胞白血病患儿预后不良的预测价值研究

The value of serum microRNA-506 combined with microRNA-146a in predicting poor prognosis in children with acute lymphoblastic leukemia

摘要:

目的 探讨血清microRNA-506（miR-506）联合microRNA-146a（miR-146a）对急性淋巴细胞白血病（ALL）患儿预后不良的预测价值。方法 随机选取江南大学附属儿童医院2020年4月—2022年4月收治的76例ALL患儿为研究组，同时选取同期在本院体检的健康儿童80例为对照组。检测并比较所有儿童血清miR-506、miR-146a表达。对研究组患儿进行规范化治疗，并进行为期1年的随访，记录患儿的预后情况，比较不同预后患儿血清miR-506、miR-146a表达。采用多因素逐步Logistic回归模型分析影响患儿预后的危险因素；绘制受试者工作特征（ROC）曲线分析miR-506联合miR-146a对患儿预后的预测价值。结果 研究组miR-506、miR-146a mRNA相对表达量高于对照组（P <0.05）。ALL患儿预后不良发生率为27.63%（21/76）。预后不良患儿miR-506、miR-146a mRNA相对表达量高于预后良好患儿（P <0.05）。预后不良与预后良好患儿的性别、年龄、体质量指数、免疫分型比较，差异均无统计学意义（P >0.05）；预后不良患儿危险程度为高危占比、初诊白细胞计数在100×10⁹/L以上占比高于预后良好患儿（P <0.05）。多因素逐步Logistic回归分析结果显示，miR-506 ［O^R =2.147（95% CI：1.294，3.559）］、miR-146a［O^R=2.251（95% CI：1.221，4.149）］是ALL患儿预后不良的危险因素（P <0.05）。ROC曲线分析结果显示，miR-506预测ALL患儿预后的敏感性为76.20%（95% CI：0.143，0.952），特异性为63.60%（95% CI：0.036，0.964）；miR-146a预测ALL患儿预后的敏感性为76.20%（95% CI：0.095，0.952），特异性为56.40%（95% CI：0.018，0.945）；两者联合预测ALL患儿预后的敏感性为90.50%（95% CI：0.048，0.962），特异性为89.10%（95% CI：0.018，0.982）。结论 miR-506与miR-146a在ALL患儿血清中异常高表达，是影响患儿预后的独立危险因素，且miR-506联合miR-146a可有效预测ALL患儿预后不良。

Abstract:

Objective To investigate the predictive value of serum microRNA-506 (miR-506) in combination with microRNA-146a (miR-146a) for adverse outcomes in children with acute lymphoblastic leukemia (ALL).Methods A total of 76 children with ALL treated at Jiangnan University Children's Hospital from April 2020 to April 2022 were included in the study group. Simultaneously, 80 healthy children who underwent medical check-ups during the same period were selected as the control group. Serum levels of miR-506 and miR-146a were measured and compared between the two groups. The study group received standardized treatment and was followed up for one year to record the outcomes of the children. The serum levels of miR-506 and miR-146a were compared between children with different outcomes. Multifactorial stepwise logistic regression analysis was used to identify risk factors for children's outcomes. Receiver Operating Characteristic (ROC) curve analysis was performed to assess the predictive value of miR-506 in combination with miR-146a for children's outcomes.Results The relative expression levels of miR-506 and miR-146a mRNA were higher in the study group than in the control group (P < 0.05). The rate of adverse outcomes in children with ALL was 27.63% (21/76). Children with adverse outcomes had higher relative expression levels of miR-506 and miR-146a mRNA compared to children with good outcomes (P < 0.05). There were no statistically significant differences in gender, age, body mass index, and immunophenotype between children with adverse and good outcomes (P > 0.05). However, a higher proportion of children with adverse outcomes were classified as high risk, and a higher proportion had an initial white blood cell count above 100×10⁹/L (P < 0.05). Multifactorial stepwise logistic regression analysis showed that miR-506 [O^R = 2.147 (95% CI: 1.294, 3.559) ] and miR-146a [O^R = 2.251 (95% CI: 1.221, 4.149) ] were independent risk factors for adverse outcomes in children with ALL (P < 0.05). ROC curve analysis revealed that miR-506 had a sensitivity of 76.20% (95% CI: 0.143, 0.952) and specificity of 63.60% (95% CI: 0.036, 0.964) in predicting outcomes in children with ALL. miR-146a had a sensitivity of 76.20% (95% CI: 0.095, 0.952) and specificity of 56.40% (95% CI: 0.018, 0.945). When combined, miR-506 and miR-146a had a sensitivity of 90.50% (95% CI: 0.048, 0.962) and specificity of 89.10% (95% CI: 0.018, 0.982) in predicting adverse outcomes in children with ALL.Conclusion High levels of miR-506 and miR-146a are independently associated with adverse outcomes in children with ALL. Moreover, a combination of miR-506 and miR-146a can effectively predict adverse outcomes in children with ALL.