肺结核患者外周血miR-23a-3p的表达及其对患者诊断及预后评估的价值分析-东南大学学报医学版

肺结核患者外周血miR-23a-3p的表达及其对患者诊断及预后评估的价值分析

单位：内江市第二人民医院检验科, 四川内江 641100

分类号：R521

出版年·卷·期（页码）：2023·42·第四期（533-539）

摘要：

目的:探究miR-23a-3p在肺结核(PTB)患者中的表达及其对PTB患者的诊断和预后的价值。方法:将2020年6月至2021年6月本院传染病科收治的98例PTB患者设为PTB组,同期另选取92例健康志愿者作为健康组。采用qRT-PCR法检测受试者外周血miR-23a-3p、核转录因子SP1(SP1)和干扰素调节因子1(IRF1)的表达;绘制受试者工作特征(ROC)曲线分析miR-23a-3p对PTB的诊断价值和预后价值;采用Pearson相关系数分析PTB患者外周血miR-23a-3p与SP1、IPF1之间的相关性;对PTB患者完成6个月随访,采用Kaplan-Meier法分析miR-23a-3p与PTB患者预后关系;Cox回归分析影响PTB患者预后的危险因素。结果:与健康组相比,PTB组患者miR-23a-3p水平显著降低,SP1和IPF1表达显著升高(P<0.05);ROC曲线显示,外周血miR-23a-3p诊断PTB的曲线下面积(AUC)为 0.861(95%CI:0.809~0.913),灵敏度和特异度分别为85.70%和70.70%;Pearson相关系数分析显示,PTB患者外周血miR-23a-3p的表达与SP1表达和IPF1表达均呈负相关(r值分别为-0.570、-0.435,均P＜0.05),PTB患者SP1表达与IPF1表达呈正相关(r=0.524,P＜0.05);随访期间,患者预后良好87例,预后不良11例;ROC曲线显示,miR-23a-3p预测PTB患者预后的AUC为 0.881(95%CI:0.790~0.971),灵敏度和特异度分别为72.70%和92.00%;与预后良好组相比,预后不良组miR-23a-3p水平显著降低,SP1和IPF1表达显著升高(P<0.05);Kaplan-Meier分析结果显示,miR-23a-3p高表达PTB患者复发率明显低于miR-23a-3p低表达患者;Cox回归分析显示,肺部空洞、痰液MTB培养阳性、miR-23a-3p低表达、SP1高表达、IPF1高表达是影响PTB患者预后的危险因素。结论:PTB患者外周血miR-23a-3p表达明显降低,其低表达是影响PTB患者预后的危险因素,对PTB诊断和预后判断均具有良好的价值。

Objective: To explore the expression of miR-23a-3p in pulmonary tuberculosis(PTB) patients and its value in the diagnosis and prognosis of PTB patients. Methods: From June 2020 to June 2021, 98 patients with PTB who were admitted to the Department of Infectious Diseases of our hospital were gathered as PTB group, and 92 healthy volunteers were gathered into healthy group. qRT-PCR method was applied to detect the expressions of miR-23a-3p, nuclear transcription factor SP1(SP1) and interferon regulatory factor 1(IRF1) in peripheral blood of the subjects.Receiver operating characteristic(ROC) curve was drawn to analyze the diagnostic value of miR-23a-3p for PTB. Pearson's method was applied to analyze the correlation between miR-23a-3p and SP1 and IPF1 in peripheral blood of the PTB patients.Completion of 6-month follow-up for the PTB patients, Kaplan-Meier method was applied to analyze the relationship between miR-23a-3p and the prognosis of the PTB patients. Cox regression was applied to analyze risk factors affecting the prognosis of the PTB patients. Results: Compared with the healthy group, the miR-23a-3p in the PTB group was obviously decreased, and the expressions of SP1 and IPF1 were obviously increased(P<0.05).The ROC curve showed that the area under the curve(AUC) of peripheral blood miR-23a-3p for the diagnosis of PTB was 0.861(95%CI:0.809-0.913), and the sensitivity and specificity were 85.70% and 70.70%, respectively.The correlation analysis by Pearson method showed that the expression of miR-23a-3p in peripheral blood of the PTB patients was negatively correlated with the expression of SP1 and IPF1(r=-0.570, P<0.05; r=-0.435, P<0.05), the expression of SP1 in peripheral blood of the PTB patients was positively correlated with the expression of IPF1(r=0.524, P<0.05).During the follow-up period of the patients, 87 cases had good prognosis and 11 cases had poor prognosis.The ROC curve showed that the AUC of miR-23a-3p to predict the prognosis of PTB patients was 0.881(95%CI:0.790-0.971), and the sensitivity and specificity were 72.70% and 92.00%, respectively.Compared with the good prognosis group, the miR-23a-3p in the poor prognosis group was obviously decreased, and the expressions of SP1 and IPF1 were obviously increased(P<0.05). Kaplan-Meier analysis showed that the recurrence rate of the PTB patients with high miR-23a-3p expression was obviously lower than that of the patients with low miR-23a-3p expression. Cox regression analysis showed that lung cavity, positive sputum MTB culture, low expression of miR-23a-3p, high expression of SP1, and high expression of IPF1 were risk factors affecting the prognosis of patients with PTB. Conclusion: The expression of miR-23a-3p in peripheral blood of patients with PTB is obviously decreased, and its low expression is a risk factor affecting the prognosis of the patients with PTB, and it has good value for the diagnosis and prognosis of PTB.

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