MicroRNA-138-5p、ATX、HO-1表达水平在LISA联合DuoPAP治疗前后的变化及对ARDS预后的评估价值

Expression changes of microRNA-138-5p, autotaxin, and heme oxygenase-1 before and after LISA combined with DuoPAP therapy and their prognostic values in neonates with acute respiratory distress syndrome

摘要:

目的 探究急性呼吸窘迫综合征新生儿（ARDS）microRNA-138-5p（miR-138-5p）、自分泌运动因子（ATX）、血红素氧合酶-1（HO-1）表达水平在微创肺表面活性物质给药（LISA）联合双水平气道正压通气（DuoPAP）治疗前后的变化及其对预后的评估价值。方法 选取2022年10月—2024年10月黄石市中心医院收治的80例ARDS患儿。患儿均采用LISA联合DuoPAP治疗，根据预后情况分为预后不良组（19例）和预后良好组（61例）。比较两组一般资料，以及治疗前后的miR-138-5p、ATX、HO-1水平变化，采用多因素一般Logistic回归模型分析ARDS患儿预后的影响因素，绘制受试者工作特征（ROC）曲线分析LISA联合DuoPAP治疗前后miR-138-5p mRNA相对表达量、ATX、HO-1水平变化对ARDS患儿预后的评估价值。结果 预后不良组胎龄、出生体重和出生5 min Apgar评分低于预后良好组（P <0.05），伴脓毒症发生率、白细胞计数、SNAPPE-Ⅱ评分、NICU住院时间≥14 d占比均高于预后良好组（P <0.05）。预后不良组miR-138-5p mRNA相对表达量、HO-1水平均低于预后良好组（P <0.05），ATX水平高于预后良好组（P <0.05）。预后不良组治疗前后miR-138-5p、ATX、HO-1的差值均小于预后良好组（P <0.05）。多因素一般Logistic回归分析结果表明：胎龄低［O^R=0.763（95% CI：0.598，0.975）］、出生5 min Apgar评分低［O^R=0.476（95% CI：0.283，0.800）］、伴脓毒症［O^R=4.433（95% CI：1.591，12.355）］、SNAPPE-Ⅱ评分高［O^R=1.536（95% CI：1.014，2.329）］、NICU住院时间长［O^R=5.989（95% CI：1.874，19.145）］、治疗前后miR-138-5p的差值小［O^R=0.344（95% CI：0.146，0.806）］、治疗前后ATX的差值小［O^R=0.977（95% CI：0.956，0.999）］和治疗前后HO-1的差值小［O^R=0.947（95% CI：0.898，0.998）］均为ARDS患儿预后不良的危险因素（P <0.05）。ROC曲线结果表明，治疗前后miR-138-5p的差值、治疗前后ATX的差值、治疗前后HO-1的差值联合检测时预测效能最高，曲线下面积为0.963，敏感性为94.7%（95% CI：0.740，0.999），特异性为98.4%（95% CI：0.912，1.000）。结论 miR-138-5p、ATX、HO-1在LISA联合DuoPAP治疗前后的变化情况对ARDS患儿预后有着良好的评估价值。

Abstract:

Objective To investigate the changes in expression levels of microRNA-138-5p (miR-138-5p), autotaxin (ATX), and heme oxygenase-1 (HO-1) before and after less invasive surfactant administration (LISA) combined with dual positive airway pressure (DuoPAP) therapy and their prognostic values in neonates with acute respiratory distress syndrome (ARDS).Methods A total of 80 neonates with ARDS admitted to our hospital from October 2022 to October 2024 were included, all of whom received LISA combined with DuoPAP therapy. According to prognosis, they were divided into a poor prognosis group (n = 19) and a good prognosis group (n = 61). General clinical data and the changes in miR-138-5p, ATX, and HO-1 levels before and after treatment were compared between the two groups. Logistic regression analysis was used to identify factors influencing prognosis in neonates with ARDS, and receiver operating characteristic (ROC) curves were constructed to assess the prognostic values of changes in miR-138-5p, ATX, and HO-1 levels before and after LISA combined with DuoPAP therapy.Results The gestational age, birth weight, and 5-min Apgar scores were lower in the poor prognosis group than in the good prognosis group, whereas the incidence of sepsis, white blood cell count, SNAPPE-II scores, and the proportion of NICU stay ≥ 14 days were higher in the poor prognosis group. The levels of miR-138-5p and HO-1 were lower in the poor prognosis group than in the good prognosis group, while ATX levels were higher in the poor prognosis group. In addition, the differences in miR-138-5p, ATX, and HO-1 levels before and after treatment were all smaller in the poor prognosis group compared with the good prognosis group. Multivariable logistic regression analysis showed that lower gestational age [O^R = 0.763 (95% CI: 0.598, 0.975) ], lower 5-min Apgar scores [O^R = 0.476 (95% CI: 0.283, 0.800) ], concomitant sepsis [O^R = 4.433 (95% CI: 1.591, 12.355) ], higher SNAPPE-II scores [O^R = 1.536 (95% CI: 1.014, 2.329) ], longer NICU stay [O^R = 5.989 (95% CI: 1.874, 19.145) ], smaller pre- and post-treatment difference in miR-138-5p levels [O^R = 0.344 (95% CI: 0.146, 0.806) ], smaller pre- and post-treatment difference in ATX levels [O^R = 0.977 (95% CI: 0.956, 0.999) ], and smaller pre- and post-treatment difference in HO-1 levels [O^R = 0.947 (95% CI: 0.898, 0.998) ] were all risk factors for poor prognosis in children with ARDS (P < 0.05). ROC curve analysis demonstrated that the combined detection of pre- and post-treatment differences in miR-138-5p, ATX, and HO-1 levels showed the highest predictive performance, with a sensitivity of 94.7% (95% CI: 0.740, 0.999) and a specificity of 98.4% (95% CI: 0.912, 1.000).Conclusion Changes in miR-138-5p, ATX, and HO-1 levels before and after LISA combined with DuoPAP therapy have significant prognostic values in neonates with ARDS.