血清microRNA-155、microRNA-23b-3p、microRNA-16-5p与难治性肺炎支原体肺炎患儿病情严重程度及预后的关系

Relationship between serum levels of microRNA-155, microRNA-23b-3p, microRNA-16-5p and severity and prognosis of refractory mycoplasma pneumoniae pneumonia in children

摘要:

目的 探讨血清microRNA-155（miR-155）、microRNA-23b-3p（miR-23b-3p）、microRNA-16-5p（miR-16-5p）水平与难治性肺炎支原体肺炎（RMPP）患儿病情严重程度及预后的关系。方法 前瞻性选取2023年6月—2023年12月杭州市儿童医院收治的101例RMPP患儿为研究对象，收集治疗前血清miR-155、miR-23b-3p、miR-16-5p水平。根据病情严重程度将患儿分为重症组39例与轻症组62例。所有患儿自治疗起随访1个月，根据治疗效果将患儿分为预后不良组22例与预后良好组79例。分析不同病情严重程度及不同预后RMPP患儿血清miR-155、miR-23b-3p、miR-16-5p水平；采用多因素逐步Logistic回归模型分析影响RMPP患儿预后的因素；绘制受试者工作特征（ROC）曲线分析血清miR-155、miR-23b-3p、miR-16-5p预测RMPP患儿预后的价值。结果 重症组患儿血清miR-155基因相对表达量高于轻症组（P <0.05），miR-23b-3p、miR-16-5p基因相对表达量均低于轻症组（P <0.05）。预后不良组患儿血清miR-155基因相对表达量高于预后良好组（P <0.05），miR-23b-3p、miR-16-5p基因相对表达量均低于预后良好组（P <0.05）。多因素逐步Logistic回归分析结果显示，儿童器官功能障碍评分2（PELOD-2）［O^R =5.129（95% CI：2.111，12.466）］、miR-155［O^R =3.924（95% CI：1.614，9.535）］、miR-23b-3p［O^R =3.850（95% CI：1.584，9.356）］、miR-16-5p［O^R =3.777（95% CI：1.554，9.179）］是影响RMPP患儿预后的危险因素（P <0.05）。ROC曲线分析结果显示，血清miR-155、miR-23b-3p、miR-16-5p及三者联合预测RMPP患儿预后的敏感性分别为63.64%（95% CI：0.408，0.820）、72.73%（95% CI：0.496，0.884）、68.18%（95% CI：0.451，0.853）、86.36%（95% CI：0.640，0.964），特异性分别为70.89%（95% CI：0.594，0.803）、78.48%（95% CI：0.675，0.866）、72.15%（95% CI：0.608，0.814）、91.14%（95% CI：0.820，0.961），曲线下面积分别为0.725（95% CI：0.622，0.827）、0.718（95% CI：0.604，0.831）、0.710（95% CI：0.591，0.829）、0.923（95% CI：0.866，0.980）。结论 血清miR-155、miR-23b-3p、miR-16-5p水平与RMPP患儿病情严重程度及预后有关，三者联合预测RMPP患儿的效能良好。

Abstract:

Objective To investigate the relationship between the levels of serum microRNA-155 (miR-155), microRNA-23b-3p (miR-23b-3p), microRNA-16-5p (miR-16-5p) and the severity and prognosis of refractory mycoplasma pneumoniae pneumonia (RMPP) in children.Methods A total of 101 children with RMPP admitted to the hospital from June 2023 to December 2023 were selected as the study objects. Serum miR-155, miR-23b-3p, miR-16-5p and other data of the children were collected, and the children were divided into severe group and mild group according to the Diagnosis and Treatment Guide for Mycoplasma pneumoniae Pneumonia in Children (2023 edition). The children were followed up for 1 month from the start of treatment and were divided into good prognosis group and poor prognosis group according to the treatment effect. The levels of serum miR-155, miR-23b-3p and miR-16-5p in children with RMPP of different severity were analyzed, and the levels of serum miR-155, miR-23b-3p and miR-16-5p in the group with good prognosis and the group with poor prognosis were analyzed as well as the factors affecting the prognosis of children with RMPP. The prognostic value of serum miR-155, miR-23b-3p and miR-16-5p in children with RMPP was analyzed.Results The relative expression level of miR-155 in severe group was higher than that in mild group (P < 0.05), and the relative expression level of miR-23b-3p and miR-16-5p in severe group was lower than that in mild group (P < 0.05). The relative expression level of miR-155 in the poor prognosis group was higher than that in the good prognosis group (P < 0.05), and the relative expression level of miR-23b-3p and miR-16-5p was lower than that in the good prognosis group (P < 0.05). Logistic regression analysis showed that organ dysfunction score 2 [O^R = 5.129(95% CI: 2.111, 12.466)] and the relative expression level of miR-155 [O^R = 3.924(95% CI: 1.614, 9.535)], the relative expression level of miR-23b-3p [O^R = 3.850(95% CI: 1.584, 9.356)], and the relative expression level of miR-16-5p [O^R = 3.777(95% CI: 1.554, 9.179)] were the risk factors affecting prognosis of children with RMPP (P < 0.05). ROC curve analysis results showed that the sensitivity of serum miR-155, miR-23b-3p, miR-16-5p, and their combination to predict the prognosis of children with RMPP were 63.64% (95% CI: 0.408, 0.820), 72.73% (95% CI: 0.496, 0.884), 68.18% (95% CI: 0.451, 0.853), and 86.36% (95% CI: 0.640, 0.964). The specificity was 70.89% (95% CI: 0.594, 0.803), 78.48% (95% CI: 0.675, 0.866), 72.15% (95% CI: 0.608, 0.814), and 91.14% (95% CI: 0.820, 0.961). And AUC were 0.725 (95% CI: 0.622, 0.827), 0.718 (95% CI: 0.604, 0.831), 0.710 (95% CI: 0.591, 0.829), and 0.923 (95% CI: 0.866, 0.980).Conclusion Serum levels of miR-155, miR-23b-3p, and miR-16-5p are related to the severity and prognosis of RMPP children, and the combination of the three is effective in predicting the prognosis of RMPP children.