The early diagnostic value of microRNA-223 for patients with complication of sepsis after ureteroscopic lithotrity / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the changes of microRNA-223 (miR-223) in patients with complication of sepsis after mini-invasive surgery of upper urinary tract stones, and to approach the value of miR-223 in the early diagnosis of sepsis. Methods Patients with upper urinary tract stones underwent micro-invasive treatment in the Department of Urology Surgery of the Affiliated Hospital of Hangzhou Normal University from January 2014 to January 2017 were enrolled. There were 60 patients with sepsis within 24 hours after surgery were assigned in the sepsis group, and 60 patients without sepsis were included in the non-sepsis group. The clinical data of miR-223, CD4+CD25+regulatory T cells (CD4+CD25+ Treg), procalcitonin (PCT) interleukin-10 (IL-10), tumor necrosis factor-α(TNF-α), C-reactive protein (CRP) in the blood, etc were collected within 24 hours after surgery. The differences in above indexes were compared between the two groups. The receiver operating characteristic curve (ROC curve) was drawn to evaluate the diagnostic values of blood mir-223, PCT and CRP in the patients, predicting whether septic complication after urinary calculi surgery would occur. Correlation analyses were used to analyze the correlations between mir-223 and CD4+CD25+ Treg, IL-10 and TNF-α. Results The miR-223 expression level and the contents of CD4+CD25+ Treg, IL-10, TNF-α, PCT and CRP in sepsis group were obviously higher than those in non-sepsis group [2&Delta;&Delta;Ct (×10-4)2.81±1.04 vs. 2.13±0.91, CD4+CD25+ Treg(×10-2) 17.61±4.48 vs. 8.37±2.71, IL-10 (ng/L) 58.42±16.38 vs. 34.68±12.45, TNF-α (pg/L) 249.41±30.69 vs. 167.54±25.98, PCT (ng/L) 4.45±1.89 vs. 0.31±0.08, CRP (μg/L)10.29±3.63 vs. 4.13±1.57, all P < 0.05); in sepsis group, the miR-223 expression and the level of CD4+CD25+ Treg (r = 0.367, P = 0.004) and IL-10 (r = 0.516, P = 0.006) were also significantly positively correlated, but miR-223 and TNF-α were not markedly correlated (r = 0.237, P > 0.05). The area under ROC curve (AUC), sensitivity, specificity and 95% confidence interval (95%CI) of miR-223 predicting sepsis occurrence after urinary operation were higher than those of CRP, PCT (AUC 0.923 vs. 0.547, 0.769, the sensitivity 81.73% vs. 71.23%, 66.59%, specificity 86.00%vs. 42.00%, 83.00%, 95%CI 0.862-0.979 vs. 0.351-0.679, 0.682-0.927). Conclusions The expression levels of plasma miR-223 in patients with sepsis after mini-invasive treatment for upper urinary tract lithotrity can reflect their immune reaction status, and can be one of the early diagnostic markers of whether the sepsis complication may occur after the surgery.