| 罗乐,张学娟,王三斌.血清 IL-6、ADAMTS-13、微 RNA-155预测急性移植物抗宿主病病人发生移植相关血栓性微血管病变的价值[J].安徽医药,2026,30(8):1600-1605. |
| 血清 IL-6、ADAMTS-13、微 RNA-155预测急性移植物抗宿主病病人发生移植相关血栓性微血管病变的价值 |
| The value of serum IL-6, ADAMTS-13, and miR-155 in predicting the occurrence of TA-TMA in patients with acute graft-versus-host disease |
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| DOI：10.3969/j.issn.1009-6469.2026.08.023 |
| 中文关键词: 急性移植物抗宿主病 移植相关血栓性微血管病变 血管性血友病因子裂解蛋白酶 微 RNA-155 白细胞介素-6 |
| 英文关键词: Acute graft-versus-host disease Thrombotic microangiopathy associated with transplantation A disintegrin and metal-loproteinase with thrombospondin motifs 13 MicroRNA-155 Interleukin-6 |
| 基金项目:云南省卫生健康委临床医学中心 2021—2023年建设项目( 202101AF120158) |
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| 中文摘要: |
| 目的探讨血清白细胞介素 -6(IL-6)、血管性血友病因子裂解蛋白酶( ADAMTS-13)、微 RNA-155(miR-155)在急性移植物抗宿主病( aGVHD)病人发生移植相关血栓性微血管病变( TA-TMA)预测价值。方法前瞻性选取 2019年 1月至 2023年 12月中国人民解放军联勤保障部队第九二〇医院收治的 198例 aGVHD病人作为研究对象，根据是否发生 TA-TMA分为 TA-TMA组和非 TA-TMA组，比较两组一般资料及血清 IL-6、ADAMTS-13、miR-155表达，采用 logistic回归分析筛选 TA-TMA发生相关因素，绘制受试者操作特征曲线( ROC曲线)、决策曲线分析血清 IL-6、ADAMTS-13、miR-155预测 TA-TMA价值。结果 198例 aGVHD病人 TA-TMA发生率为 20.71%；TA-TMA组血清 IL-6(20.22±6.60)pg/L、miR-155 2.55±0.76表达高于非 TA-TMA组［( 14.14±4.28)pg/L、1.76±0.51］，ADAMTS-13(55.51±8.84)%低于非 TA-TMA组( 65.63±10.23)%，差异有统计学意义( P<0.05)； aGVHD移植后 60 d发病及起始严重程度 Ⅲ度及以上、 IL-6、miR-155、ADAMTS-13是 aGVHD病人 TA-TMA发生的相关因素( P<0.05)； IL-6、miR-155、ADAMTS-13联合预测 TA-TMA的曲线下面积( AUC)为 0.92，优于单一预测( AUC:0.80、0.77、0.79)，当阈值 0~0.9时，三者联合预测 TA-TMA的净收益率较大。结论血清 IL-6、ADAMTS-13、miR-155是 aGVHD病人发生 TA-TMA相关因素，联合检测有助于提高 TA-TMA预测效能，指导临床诊治，使更多病人获益。 |
| 英文摘要: |
| Objective To explore the predictive value of serum interleukin-6 (IL-6), a disintegrin and metalloproteinase with throm-bospondin motifs 13 (ADAMTS-13), and microRNA-155 (miR-155) in the occurrence of transplant-associated thrombotic microangiop-athy (TA-TMA) in patients with acute graft-versus-host disease (aGVHD). Methods Prospective selection of 198 patients withaGVHD admitted to the 920th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army from January 2019 toDecember 2023 were selected as the research subjects. They were divided into the TA-TMA group and the non-TA-TMA group accord-ing to whether TA-TMA occurred. The general information and the expression of serum IL-6, ADAMTS-13, and miR-155 were com-pared between the two groups. The logistic regression equation was used to screen the influencing factors of TA-TMA occurrence. The receiver operating characteristic (ROC) curve and decision curve were used to analyze the predictive value of serum IL-6, ADAMTS-13, and miR-155 for TA-TMA.Results The incidence of TA-TMA in 198 aGVHD patients was 20.71%; Serum IL-6 (20.22±6.60) pg/ L and miR-155 2.55±0.76 in the TA-TMA group were higher than (14.14±4.28) pg/L and 1.76±0.51 in the non-TA-TMA group, while ADAMTS-13 (55.51±8.84)% was lower than (65.63±10.23)% , with statistically significant differences (P<0.05). The onset and initial severity of grade Ⅲ or higher aGVHD 60 days after transplantation, as well as IL-6, miR-155, and ADAMTS-13, are influencing factors for the occurrence of TA-TMA in aGVHD patients (P<0.05). The AUC of the combined prediction of IL-6, miR-155, and ADAMTS-13 for TA-TMA was 0.92, which was superior to the individual predictions (AUC: 0.80, 0.77, 0.79). When the threshold was set between 0and 0.9, the net profit rate of the combined prediction of the three factors for TA-TMA was higher.Conclusions Serum IL-6, AD-AMTS-13 and miR-155 are the influencing factors for the occurrence of TA-TMA in aGVHD patients. Combined detection is helpful to improve the predictive efficacy of TA-TMA, guide clinical diagnosis and treatment, and benefit more patients. |
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