| Severe acute pancreatitis(SAP) is a kind of commonclinical emergency, it’s accounted for15%to20%of acute pancreatitis(AP). In recent years. the incidence of SAP presents the trend of increasing and the mortality still remains high. The United States reported thatabout300.000patients suffering from AP each year, a mortality rate of between1%to3%and the SAP mortality rate was up to30%to50%. With the improvement of medical care in nearly50years.SAP treatment success rate has been increased in a certain extent.but its pathogenesis has not been fully elucidated. The clinician is poor at predicting the severity of AP at the bedside. Therefore, early diagnosis and assessment of prognosis for SAP is essential.MIRNAs is a kind of smallendogenous18～25-nucleotide non-coding single-stranded RNA which may suppress the protein generation in metazoan through targeting complementary regions in3’ untranslated regions. In2008, Jeyaseelan firstly reported that microRNA could stably exist in plasma, it suggests that miRNAs may have very important significance in the diagnosis of stroke and other brain-related diseases. The latesttwo articles reported:miR-208,122,133a, and124may play a very important role in the diagnosis of cardiac muscle, liver, muscle, and brain injury. These strongly suggest that: tissue-specific miRNAs may play a very important role in the early diagnosis of the tissue damage.Ourpioneerstudies have shownthat miR-216a was specifically expressed in rat pancreas. MiR-216a gene sequence was confirmed to be highly conserved in human, mouse, rat, and zebrafish. This suggests that the phenomenon of animal models may be similar to the incidence of the human body. In human genome, miR-216a and miR-217are co-located on chromosome2in a non-coding RNA. Therefore, we infer that:miR-216a or miR-217is highly expressed in human pancreatic. Previous studies have shown that tissue-specific expression of miRNAs in tissue injury case released into the blood as markers, and reflected the degree of tissue damage. For example, high plasma miR-208a expression reflects early myocardial injury and increased circulating miR-122and miR-155in Alcoholic Liver Disease. The above theory support of miR-216a or miR-217as a marker of pancreatic injury. Serum amylase is generally used as a sensitive indicator for the diagnosis of APin clinic,but italso increased in cholecystitis, bowel obstruction and other diseases, by contrast, the pancreas-specific microRNA is valuble for the differential diagnosis.There is norelated clinical research on microRNA of circulationblood and AP. Based on the above theory. this subjectmonitor the plasma miR-216a and miR-217expression levels of clinical patients and healthy peopleby Real-time PCR to assess the diagnostic value of acute pancreatitis. This study consists of two parts, as described below.1. The diagnostic value of plasma miR-216a and miR-217in acute pancreatitis.Aim:To assess diagnostic value of theplasma miR-216a and miR-217relative expression in AP.Methods:After admission24h,48h,72h,werespectively collected mild acute pancreatitis(MAP) and SAPpatients’plasma, meanwhile normal plasma as control. Plasma miR-216a and miR-217expression levels were detected by real-time quantitative PCR, cel-miR-39as a reference.We compared the difference in expression levelsand the relationship between plasma miRNAs and phase changed in the groups.Results:14MAPpatients,20SAPpatients, and14normal controls were enrolled. Plasma miR-216a and miR-217were measured by real-time PCR. The MAP and SAP patients’24h plasma miR-216a relative expression levels after hospitalization were-5.48,-3.06, significantly higher than the normal level of-7.82(P<0.001). This indicates that the pancreatic injury and necrosis caused by acute pancreatitis may lead to the release of specific miRNAs into the blood, resulting in abnormally elevated levels. Compared with MAP,the relative expression level ofmiR-216a in the SAP group was statistically significanthigher than the MAP group (P=0.012, P<0.05) which indicates thatelevated plasma miR-216a in AP can to some extent reflect the severity of pancreatitis. While compare the24h plasma miR-217relative expression levels after hospitalization of the two patients’ group (-1.85,-0.75) with the normal group (-2.45), the difference wasn’tstatistically significant (P=0.068, P>0.05).This showed miR-217was unrelated with AP. Compared with patients hospitalized after24h and72h, plasma miR-216a expression levels in the SAP group showed a downward trend, but no statistically significant(P=0.192, P>0.05), as well as the MAP group (P=0.320, P>0.05). MiR-216a has no significant correlation with the corresponding periodserum amylase levels in the patients’group(P=0.136, P>0.05). The area under the ROC curve of the miR-216a for the diagnosis of AP is0.863(95%confidence interval CI:0.748-0.979); The area under the ROC curve of the miR-216a for the diagnosis of SAP is0.850(95%CI:0.740-0.960). when boundary value took-5.34, the sensitivityofmiR-216a for the diagnosis of AP was73.5%and the specificity was92.9%. The sensitivity of miR-216a for the diagnosis of SAP was90%and the specificity was92.9%.Conclusions:Plasma miR-216a can be used as specific markers reflecting pancreatic injury in AP. It has a great diagnostic value on AP and could be used as aindicator estimating the severity of AP.2.The correlation analysis of the clinical features in acute pancreatitis with miR-216aAim:Evaluate the correlation of plasma miR-216a expression levels and clinical features in acute pancreatitis.Methods:We summarized the results of plasma miR-216a expression levels and combined with clinical features ofpatients with AP. SPSS15.0software was used to analyze the correlation between plasma miR-216a relative expression levels and the patients’gender, age. time of onset. Balthazar CTSI and duration of hospitalization in MAP and SAP.Results:The average plasma miR-216a expression levels negatively correlated with the time of onset in patients with AP after admission(r=-0.355, P=0.039, P<0.05) which Implied that plasma miR-216a expression levels gradulally reduced with the extension of the course. miR-216a expression levelshas no significant correlation with gender and age(P=0.157, P=0.501, P>0.05). miR-216a expression levels has no significant correlation with Balthazar CTSI (P=0.678, P>0.05). miR-216a expression levels has no significant correlation with duration of hospitalization (P=0.337,P>0.05).Conclusions:The plasma miR-216a expression level was negatively correlated with the time of onset. There was no significant correlation between plasma miR-216a expression levels with acute pancreatitis, gender, age, Balthazar CT score (CTSI) and hospitalization days. |
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