| Objectives: Characterized by pancreatitis characterized by severe acute pancreatitis(SAP),one of the most common acute illnesses seen in emergency rooms today is clinically significant and characterized by variable morbidity that can result in complications from a wide variety of organ systems.The main cause of death is also closely related to its complications.Acute respiratory distress syndrome(ARDS)is one of the most common complications of SAP.Due to the rapid occurrence of symptoms,early diagnosis symptoms are not typical,leading to clinicians in the examination,treatment,and other aspects of the great challenge.In the present clinical work,there is no rapid and efficient treatment for ARDS.Early identification of patients’ disease progression,so as to grasp the best time to deal with it,has a great impact on the prognosis of patients.Micrornas(mirnas)play a key role in the process of human life activities,participating in many important life processes,including inflammation,cell growth,differentiation,etc.The abnormal expression is closely related to the progression of many diseases.In recent years,it has been regarded as an ideal biomarker for disease diagnosis and prognosis monitoring due to its wide access and not affected by sample processing errors.Therefore,miRNAs are widely used to study disease progression in a variety of diseases,given its potential as a novel,non-invasive potential biomarker.In this paper,miR-1246 and miR-762 were screened out by referring to a large number of articles and database prediction,and the above two mirnas were selected as research objects.In view of the fact that both of the above two mirnas belong to inflammatory regulatory factors,and their relative expression levels have also changed abnormally in the in vitro lung injury model test,the main purpose of this study is to evaluate the relative expression levels of miR-1246 and miR-762 in peripheral blood of patients with SAP and SAP combined with ARDS in the two groups and patients with different degrees Correlation of clinical data,length of stay,CTSI score,Acute Physiology And Chronic Health Evaluation Ⅱ(APACHE-Ⅱ)and other clinical data,This can provide a theoretical basis for the early identification and treatment of ARDS patients with SAP in the future.Methods: A case-control study design was adopted in this study.The 116 SAP patients were collected from the First People’s Hospital of Yunnan Province from September 2020 to October 2022.According to the inclusion and exclusion criteria,70 patients qualified for inclusion were finally identified according to whether they were complicated with acute respiratory distress syndrome(ARDS)was divided into nonARDS(N-ARDS)group(28 cases)and ARDS group(42 cases).At the same time,30 healthy people were also collected in the First People’s Hospital of Yunnan Province as healthy controls for this study from November 2020 to December 2020 were selected as the Control group,and the general data of the healthy people were collected.Medical data,such as gender,age,date of hospitalization,imaging examination,APACHE-Ⅱ score and CTSI score of patients 24 hours after admission were collected to record the cause of disease,clinical symptoms,imaging examination,length of stay and prognosis of patients during hospitalization.Venous blood was collected from patients eligible for inclusion after admission.Real-time quantitative PCR(RT-q PCR)was used to detect the expression of corresponding target genes in the ARDS and N-ARDS groups were determined The expression levels of target RNA in peripheral blood of patients in the above two groups were analyzed simultaneously and compared with the results of various clinical tests and treatment and common clinical data.In this study,IBM SPSS Statics 26.0 was used to carry out data processing and statistical analysis.Continuous data satisfying normal distribution were represented by mean ± standard deviation(x±s),and classification information was described by case number(%).The expression levels of miR-1246 and miR-762 in peripheral blood of patients in the three groups were firstly analyzed by one-way analysis of variance,and then compared by least significant difference(LSD-T).The difference between groups of classified data can be detected by chi-square test.Logistic multivariate regression was used to analyze the risk factors of ARDS in patients with severe acute pancreatitis(SAP),and receiver characteristic operation(ROC)curve was drawn to analyze miR-1246,miR-762,APACHE-Ⅱ score,CTSI score,and SAP combined with ARD The therapeutic value of S,pearson correlation analysis method was used for continuous variables.P<0.05 indicates the statistical value of the difference.Results: 1.The overall causes of onset of severe acute pancreatitis collected in this study from high to low mainly included gallbladder onset,alcohol onset,lipid origin,and unknown cause.According to the age division of the analysis of the causes of the disease were mainly: the young group,the unknown cause of the disease was the first;In the middle age group,lipid origin was the first.Gallbladder onset was the first in the aged group.The causes of the disease were analyzed according to different genders: the causes of male disease were mainly lipid origin;The main cause of female onset was bile origin.2.Comparison of the expression levels of miR-1246 and miR-762 in peripheral blood of the N-ARDS group,The expression levels of miR-1246 and miR-762 in peripheral blood of the three groups were relatively high,and the expression levels of target gene in ARDS group and N-ARDS group were higher than those in healthy control group.The expression levels of miR-1246 and miR-762 in peripheral blood of ARDS group were higher than those of N-ARDS group.3.Comparison of clinical indexes between N-ARDS group and ARDS group:There were no significant differences in gender,age,body mass index(BMI)and cause of disease between the N-ARDS group and the ARDS group,but there were significant differences in APACHE-Ⅱ scores,CTSI score,length of stay in ICU,relative expression of miR-1246 and miR-762 between the two groups(P<0.05).4.Analysis of independent risk factors affecting ARDS in SAP patients: Logistic regression analysis showed that APACHE-Ⅱ score,CT score,and expression levels of miR-1246 and miR-762 in peripheral blood were independent risk factors leading to ARDS in SAP patients.5.The diagnostic value of the expression of miR-1246 and miR-762 in peripheral blood for ARDS patients with SAP: the ROC curve of peripheral blood miR-1246 and miR-762 for ARDS patients was drawn,and the results showed that both of them had considerable therapeutic significance for the expected value of disease development.The decline area of AUC was 0.849 and 0.735,respectively.The AUC of combined diagnosis of the two was 0.869,indicating that both of them had considerable therapeutic effect on the prediction of disease development,among which the expression of miR-1246 was better than that of miR-762,and the AUC and sensitivity of the two combined diagnosis were the highest.6.The diagnostic value of APACHE-Ⅱ score and CTSI score on SAP concurrent ARDS: The results of APACHE-Ⅱ score and CTSI score on receiver operating characteristic(ROC)curve showed that both of them had certain reference significance on the influence of SAP concurrent ARDS.The best cut-off value of APACHE-Ⅱ score for predicting SAP concurrent ARDS was 13,and the sensitivity was 88.10%.The best cut-off value of CTSI score in predicting SAP concurrent ARDS was 5,and the sensitivity was 95.24%.These results indicated that both of them had significant diagnostic and treatment significance,and CTSI score was higher than APACHE-Ⅱ score.Conclusions: This study showed that the relative expression levels of miR-1246 and miR-762 in peripheral blood and their expression levels in peripheral blood of patients with SAP and ARDS were significantly increased,which was positively correlated with the development of SAP.At the same time,their relative expression levels were closely related to APACHE-Ⅱ score,CTSI score and length of stay.When APACHE-Ⅱ score is greater than 13 and CTSI score is greater than 5,SAP patients are more likely to develop ARDS,and CTSI score is better than APACHE-Ⅱ score in predicting the disease progression of SAP combined with ARDS.miR-1246 and miR-762 have certain value in predicting the early condition of SAP complicated with ARDS,and their combined diagnosis accuracy is higher.The corresponding expression levels of miR-1246 and miR-762 can be detected clinically to clearly predict the severity of SAP disease and whether ARDS will occur in the future.In addition,early mechanically assisted ventilation and clinical intervention can be used to prevent or delay the progressive progression of the disease in SAP patients who are about to develop ARDS,thus further reducing the mortality of SAP patients. |
