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发布时间：2022-07-25 11:33:44

NEAT1 和 miR-146a 在结核性与恶性胸腔积液鉴别诊断中的价值
韩  莉，徐红艳，马  维，龚军侠，侯睿康，谷红红，辛  涛 　　[ 摘要 ] 目的 探究长链非编码 RNA（long-chain non-coding RNA, LncRNA）核富含丰富的转录本 1（nuclear enriched  abundant transcript 1, NEAT1）和微小 RNA-146a（microRNA-146a, miR-146a）在结核性与恶性胸腔积液鉴别诊断中的价值。 方法 选取 2019 年 3 月—2021 年 3 月我院收治的 103 例结核性胸腔积液患者（结核组）和 46 例恶性胸腔积液患者（恶性 组）作为研究对象。采用 ELISA 法检测患者血清及胸腔积液中 TNF-α、CRP、降钙素原（procalcitonin, PCT）和 IL-6 的水平。 采用实时荧光定量 PCR（real-time flfluorescence quantitative PCR, qRT-PCR）法检测患者血清及胸腔积液中 NEAT1、miR- 146a 的表达水平。采用 Pearson 相关性分析分析血清及胸腔积液中 NEAT1、miR-146a 与炎性因子之间的关系。采用 ROC 曲线分析血清及胸腔积液中 NEAT1、miR-146a 单项及联合检测对结核性与恶性胸腔积液的鉴别诊断价值。结果 结核组患 者血清及胸腔积液 TNF-α、CRP、PCT 和 IL-6 水平均显著高于恶性组（P 均＜ 0.05）。恶性组患者血清及胸腔积液 NEAT1 水平均显著高于结核组，而 miR-146a 水平均显著低于结核组（P 均＜ 0.05）。Pearson 相关性分析结果显示，血清及胸腔积 液中 NEAT1 与 TNF-α（r 分别为 -0.474、-0.516，P 均＜ 0.05）、IL-6（r 分别为 -0.507、-0.527，P 均＜ 0.05）均呈负相关， 与 CRP、PCT 无相关性（P 均＞ 0.05）；miR-146a 与 TNF-α（r 分别为 0.568、0.573，P 均＜ 0.05）、CRP（r 分别为 0.493、 0.518，P 均＜ 0.05）、PCT（r 分别为 0.468、0.509，P 均＜ 0.05）、IL-6（r 分别为 0.601、0.612，P 均＜ 0.05）均呈正相关。 ROC 曲线分析显示，血清中 NEAT1、miR-146a 2 者联合检测对结核性与恶性胸腔积液鉴别诊断的 AUC 为 0.848，敏感度为 71.70%，特异度为 98.10%；胸腔积液中 NEAT1、miR-146a 2 者联合检测对结核性与恶性胸腔积液鉴别诊断的 AUC 为 0.862， 敏感度为 84.80%，特异度为 89.30%。血清 2 者联合鉴别诊断结核性与恶性胸腔积液的 AUC 小于胸腔积液 2 者联合鉴别诊断 的 AUC，但差异无统计学意义（Z=0.257，P=0.798）。结论 NEAT1、miR-146a 在结核性与恶性胸腔积液患者中的水平呈 异常表达，血清 NEAT1 联合 miR-146a 水平可作为鉴别结核性与恶性胸腔积液的主要检测手段，同时可辅助分析胸腔积液 中 NEAT1、miR-146a 水平，使诊断结果更具有可靠性。　　 　　[ 关键词 ] 长链非编码 RNA；核富含丰富的转录本 1；结核性胸腔积液；恶性胸腔积液；微小 RNA；微小 RNA- 146a；炎性因子；诊断 　　[ 中国图书资料分类号 ]　R730.4；R561.3　　 [ 文献标志码 ] A　　　　[ 文章编号 ]　1007-8134(2022)03-0248-06 　　DOI: 10.3969/j.issn.1007-8134.2022.03.013 The value of NEAT1 and miR-146a  in the differential diagnosis of tuberculous and malignant pleural effusions
HAN Li, XU Hong-yan* , MA Wei, GONG Jun-xia, HOU Rui-kang, GU Hong-hong, XIN Tao Department 3 of Internal Medicine, the Tuberculosis Control and Prevention Hospital of Shaanxi Province, Xi'an 710105, China *Corresponding author, E-mail: urvhy2@163.com 　　[Abstract] Objective To explore the value of long-chain non-coding RNA (LncRNA) nuclear enriched abundant  transcript 1 (NEAT1) and microRNA-146a (miR-146a) in the differential diagnosis of tuberculous and malignant pleural effusions.  Methods During March 2019 to March 2021, 103 patients with tuberculous pleural effusion (tuberculosis group) and 46 patients with  malignant pleural effusion(malignant group) treated in our hospital were selected as the research objects. ELISA was used to detect the  levels of TNF-α, CRP, procalcitonin (PCT) and IL-6 in serum and pleural effusion. Real-time fluorescence quantitative PCR (qRT-PCR)  was used to detect the expression levels of NEAT1 and miR-146a in serum and pleural effusion. Pearson correlation was used to analyze  the relationship between NEAT1, miR-146a and inflammatory factors in serum and pleural effusion. ROC curve was used to analyze  the differential diagnosis value of NEAT1 and miR-146a in serum and pleural effusion and their combined detection of tuberculous  and malignant pleural effusion. Results The TNF-α, CRP, PCT, and IL-6 levels in serum and pleural effusion in the tuberculosis  group were significantly higher than those in the malignant group (P ＜ 0.05). The NEAT1 levels in serum and pleural effusion in the  malignant group were significantly higher than those in the tuberculosis group, while the miR-146a level was significantly lower than that  in the tuberculosis group (P ＜ 0.05). The results of Pearson correlation analysis showed that NEAT1 in serum and pleural effusion was  negatively correlated with TNF-α (r=-0.474, -0.516, P ＜ 0.05) and IL-6 (r=-0.507, -0.527, P ＜ 0.05), and was no correlated with CRP  and PCT (P ＞ 0.05); miR-146a was positively correlated with TNF-α (r=0.568, 0.573, P ＜ 0.05), CRP (r=0.493, 0.518, P ＜ 0.05), PCT  (r=0.468, 0.509, P ＜ 0.05) and IL-6 (r=0.601, 0.612, P ＜ 0.05). ROC curve analysis showed that the AUC for the differential diagnosis  of tuberculous and malignant pleural effusion by the combination detection of NEAT1 and miR-146a in serum was 0.848, the sensitivity  was 71.70%, and the specificity was 98.10%; the AUC of combined detection NEAT1 and miR-146a in pleural effusion in the differential  diagnosis of tuberculous and malignant pleural effusion was 0.862, the sensitivity was 84.80%, and the specificity was 89.30%; the AUC of the combination of levels in serum in the differential diagnosis of tuberculous and malignant pleural effusion was lower than that of the

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