ROC analysis of the relationship between high mobility group protein B1, microRNA-223 and emergency infection and the prognosis of severe pneumonia
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摘要: 目的 探讨高迁移率族蛋白B1(HMGB1)、微小RNA-223(miR-223)与急诊感染三项[超敏C-反应蛋白(hs-CRP)、IL-6、降钙素原(PCT)]的关系，及对重症肺炎(SP)预后的预测价值。方法 选取2018年2月-2020年8月82例SP患者为观察组，根据年龄、性别匹配普通肺炎患者(82例)为对照1组，健康体检人群(82例)为对照2组。比较3组HMGB1、miR-223及急诊感染三项的水平，分析观察组HMGB1、miR-223与急诊感染三项的关系，logistic回归分析HMGB1、miR-223及急诊感染三项与SP的关联性，受试者工作特征曲线分析HMGB1、miR-223对SP预后的预测价值。结果 观察组HMGB1、miR-223及IL-6、PCT、hs-CRP水平均高于对照1组、对照2组，对照1组高于对照2组(P< 0.05)；观察组患者HMGB1、miR-223均与hs-CRP、IL-6、PCT呈正相关(P< 0.05)；logistic回归分析显示，HMGB1、miR-223及急诊感染三项均与SP相关(P< 0.05)；死亡者HMGB1、miR-223及hs-CRP、IL-6、PCT水平高于好转者(P< 0.05)；HMGB1、miR-223联合预测SP预后的曲线下面积最大，为0.889，对应的敏感度为95.65%，特异度为70.11%。结论 SP患者HMGB1、miR-223异常高表达，且与急诊感染三项水平关系密切，可为临床评估SP的预后提供参考。Abstract: Objective To explore the relationship between high mobility group protein B1(HMGB1), microRNA-223(miR-223) and emergency infections, and their predictive value for the prognosis of severe pneumonia(SP).Methods From February 2018 to August 2020, 82 cases of SP patients in our hospital were selected as the observation group, 82 cases of common pneumonia matched by age and sex were selected as the control group 1 and 82 cases of healthy people were selected as the control group 2. The levels of HMGB1, miR-223 and emergency infection in the two groups were compared, the relationship between HMGB1, miR-223 and emergency infection in the observation group was analyzed, the association between HMGB1, miR-223 and emergency infection and SP was analyzed by logistic regression model, and the predictive value of HMGB1 and miR-223 on the prognosis of SP was analyzed by receiver operating characteristic(ROC) curve.Results The observation group HMGB1, miR-223, interleukin-6(IL-6), procalcitonin(PCT), and high-sensitivity C-reactive protein(hs-CRP) levels were higher than those of the control group 1 and control group 2, the control group 1 was higher than the control group 2(P< 0.05); HMGB1 and miR-223 in SP patients were positively correlated with hs-CRP, IL-6, and PCT(P< 0.05); logistic regression analysis showed that HMGB1, miR-223 and emergency infection were all related to SP(P< 0.05); the levels of HMGB1, miR-223, hs-CRP, IL-6, and PCT of the dead were higher than those who had improved(P< 0.05); the maximum AUC of HMGB1 and miR-223 predicting the prognosis of SP was 0.889, the corresponding sensitivity was 95.65%, and the specificity is 70.11%.Conclusion HMGB1 and miR-223 are abnormally highly expressed in SP patients, and are closely related to the three levels of emergency infection, which can provide references for clinical evaluation of the prognosis of SP.
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表 1 3组HMGB1、miR-223水平及急诊感染三项水平的比较
X±S 组别 例数 HMGB1/ (mg·L-1) miR-223/ (×10-4) hs-CRP/ (pg·mL-1) IL-6/ (pg·mL-1) PCT/ (ng·mL-1) 观察组 82 3.59±0.84 17.04±4.86 18.39±4.57 35.74±6.36 7.86±0.83 对照1组 82 1.93±0.58 11.35±3.94 10.86±3.27 21.52±5.84 5.32±0.76 对照2组 82 0.76±0.35 6.17±2.04 4.37±1.06 12.69±2.85 1.09±0.51 F 427.196 167.926 370.340 402.414 1 884.759 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 HMGB1、miR-223及急诊感染三项与SP的关联性
变量 β SE Wald χ2 P OR 95%CI HMGB1 1.299 0.374 12.066 < 0.001 3.666 1.961~6.854 miR-223 1.258 0.351 12.841 < 0.001 3.519 2.141~5.783 hs-CRP 1.043 0.476 4.798 0.037 2.837 1.254~6.417 IL-6 1.046 0.321 10.610 < 0.001 2.845 1.362~5.943 PCT 1.239 0.382 10.524 < 0.001 3.453 2.016~5.914
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表 3 观察组不同预后患者HMGB1、miR-223及急诊感染三项水平比较
X±S 组别 例数 HMGB1/ (mg·L-1) miR-223/ (×10-4) hs-CRP/ (pg·mL-1) IL-6/ (pg·mL-1) PCT/ (ng·mL-1) 死亡 25 4.15±1.12 20.25±4.37 22.61±5.76 41.28±7.29 8.51±1.08 好转 57 3.34±0.79 15.63±2.96 16.54±3.91 33.31±6.25 7.57±0.61 t 3.745 5.592 5.568 5.050 5.016 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 4 HMGB1、miR-223对SP预后的预测价值
指标 AUC 95%CI χ2 P cut-off值 敏感度/% 特异度/% HMGB1 0.757 0.649~0.846 4.220 < 0.001 >3.92 60.87 80.70 miR-223 0.829 0.763~0.894 5.527 < 0.001 >16.28 82.61 75.44 联合预测 0.889 0.794~0.939 7.853 < 0.001 95.65 70.11
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