The Correlation Between Plasma MicroRNA Levels And The Severity And Prognosis Of ARDS Patients:a Clinical Observational Study

Part One:The correlation between plasma microRNA levels and the severity and prognosis of ARDS patients:a clinical observational studyObjective:This study is to investigate the correlation between plasma MSC-VEC-miRNA(relating to mesenchymal stem cells,vascular endothelial cell and previously studied in ARDS)levels and the severity of ARDS patients and predictive value of plasma MSC-VEC-miRNA levels for prognosis.Methods:1.MSC-VEC-miRNA screening:PUBMED database is used to retrieve relevant literatures through keywords and Subject words.We read the literatures and get MSC-VEC-miRNA.2.Collection of cases:The eligibles are obtained from patients admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from Jan 2016 to sept 2016,diagnosed ARDS.We collected peripheral blood from patients within 24 hours after ARDS diagnosed,and then collected the plasma after centrifugation.3.Patient data collection:basic information(age,height and weight),general information(diagnosis,APACHEII score,SOFA score,ARDS etiology);oxygen therapy and parameters(noninvasive ventilation and invasive ventilation parameters),ARDS severity(Murray lung injury score)and prognostic index(28 days mortality rate).4.Plasma miRNA detection:the Cycle threshold(CT)value of each MSC-VEC-miRNA was detected by real-time fluorescence quantitative PCR.5.Detection of plasma endothelial injury markers and inflammatory factors:the concentrations of VCAM-1,vWF,TNF-?,IL-10 in plasma were detected by ELISA method.Results:1.Screening of MSC-VEC-miRNA:there are 14 kinds of eligibles,miR-15a,miR-16,miR-21,miR-24,miR-26a,miR-27a,miR-27b,miR-126,miR-146a,miR-150,miR-155,miR-221,miR-223,miR-320.2.The comparison of general situation between survival group and death group:57 eligibles were included in the study.28 days case fatality rate was 31.6%.The general situation comparison:Age,BMI,underlying diseases,the cause of ARDS,PEEP,P/F had no statistical difference(P>0.05)between two groups.APACHE ? score(26.9 ? 8.5),SOFA score(13.7±3.9)and blood lactic acid(3.1[1.2-5.2])in death group was significantly higher than that(18.7? 7.1,P<0.001),(8.9±4.5,P<0.001),(1.7[0.9-2.4],P=0.01)in survival group.Murray score in the death group was significantly higher than that in the survival group(2.8[2.3-3.7]vs.2.3[1.7-2.7],P=0.01).3.The comparison of MSC-VEC-miRNA,vascular endothelium injure markers,inflammatory factor between survival group and death group:Plasma miR-26a level in death group exhibits significantly lower than that in survival group(0.33[0.09-1.17]vs.0.97[0.17-3.49],P=0.046),however,plasma miR-320 level in death group exhibits significantly higher than that in survival group(0.37[0.16-1.66]vs.0.18[0.07-0.39],P=0.041).Other 12 kinds of miRNA levels in plasma in the two groups showed no statistical difference(P>0.05).Between the two groups,plasma level of vWF,VCAM-1,TNF-?,IL-10 showed no statistical difference(P>0.05).4.The comparison of MSC-VEC-miRNA,vascular endothelium injure markers,inflammatory factor among moderate,medium and severe group:Plasma levels of MSC-VEC-miRNA showed no statistical difference among moderate,medium and severe ARDS patients(P>0.05).Plasma vWF,VCAM-1,TNF-a,IL-10 levels showed no statistical difference in three groups of patients(P>0.05).5.NSC-VEC-miRNA predictive value in prognosis of ARDS:(1)miR-26a:AUC=0.67,p<0.05,(2)miR-320:AUC=0.67,p<0.05,(3)joint miR-26a and miR-320:AUC=0.75,p<0.001?Conclusion:Plasma miR-26a,miR-320 are good predictors of 28 days prognosis in ARDS patients.Part Two:The difference in plasma microRNA levels between ARDS originating from pulmonary disease(ARDSp)and ARDS originating from extra-pulmonary disease(ARDSexp):a clinical observational studyObjective:This study is to investigate the difference in plasma levels of MSC-VEC-miRNA(relating to mesenchymal stem cells,vascular endothelial cell and previously studied in ARDS)between ARDS originating from pulmonary disease(ARDSp)and that originating from extra-pulmonary disease(ARDSexp).Methods:1.MSC-VEC-miRNA screening:PUBMED database is used to retrieve relevant literatures through keywords and Subject words.We read the literatures and get MSC-VEC-miRNA.2.Collection of cases:The eligibles are obtained from patients admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from Jan 2016 to sept 2016,diagnosed ARDS.We collected peripheral blood from patients within 24 hours after ARDS diagnosed,then collected the plasma after centrifugation.3.Patient data collection:basic information(age,height and weight),general information(diagnosis,APACHEII score,ARDS etiology);oxygen therapy and parameters(noninvasive ventilation and invasive ventilation parameters,and ARDS severity(Murray lung injury score),prognostic index(28 days mortality rate).4.Plasma miRNA detection:the Cycle threshold(CT)value of each MSC-VEC-miRNA was detected by real-time fluorescence quantitative PCR.5.Detection of plasma endothelial injury markers and inflammatory factors:the concentrations of VCAM-1,vWF,TNF-?,IL-10 in plasma were detected by ELISA method.Results:1.1.Screening of MSC-VEC-miRNA:there are 14 kinds of eligibles,miR-15a,miR-16,miR-21,miR-24,miR-26a,miR-27a,miR-27b,miR-126,miR-146a,miR-150,miR-155,miR-221,miR-223,miR-320.2.The comparison of general situation between ARDSp and ARDSexp:57 eligibles were included in the study,43 cases in ARDSp group and 14 cases in ARDSexp group.The general situation comparison between ARDSp and ARDSexp:Age,BMI,lactic acid,APACHE ? score,SOFA score,28-day mortality rate had no statistical difference(P>0.05)between two groups.The severity of ARDS comparison between ARDSp and ARDSexp:Oxygenation index(P/F)in pulmonary ARDS group was lower than that in extra-pulmonary ARDS(145[119-203]vs.206[184-253],P=0.012).Murray lung injury score in pulmonary ARDS group was significantly higher than extra-pulmonary ARDS group(2.7[2-3.3]vs.1.8[1.3-2.4],P=0.008).FiO2 and PEEP had no statistical difference between two groups(P>0.05).3.The comparison of MSC-VEC-miRNA between ARDSp and ARDSexp:Plasma miR-221(0.22[0.12-0.49])?miR-27b(0.34[0.10-0.46])levels were significantly lower in ARDSexp than that in ARDSp(0.57[0.22-1.57],P=0.008)?(0.60[0.20-1.46],P=0.025).Other miRNA in had no obvious plasma level difference between the two groups(P>0.05).4.The comparison of vascular endothelium injure markers,inflammatory factor between ARDSp and ARDSexp:Plasma vWF concentration was significantly lower in ARDSexp than that in ARDSp(0.77[0.29-1.54]vs.1.80[0.95-3.51],P=0.048).While VCAM-1,IL-10,TNF-? plasma concentrations had no statistical difference in the two groups of patients(P>0.05).Conclusion:Plasma miR-221,miR-27b,vWF levels were significantly lower in ARDSexp group than that in ARDSp group.