通讯作者: 陈臻, w15722907113@163.com

DOI：10.12201/bmr.202604.00163

Correlation between the Expression of Peripheral Blood miR-145-5p and miR-223 and Treatment Response and Prognosis in Patients with Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Tuberculosis

• 摘要：目的? 探讨慢性阻塞性肺疾病(COPD)合并肺结核(PTB)患者外周血微小RNA-145-5p(miR-145-5p)、微小RNA-223(miR-223)表达水平与治疗应答及预后的相关性。方法? 选取2022年3月—2024年3月于该院就诊的COPD合并PTB患者180例作为研究组,另选取同期COPD患者60例、PTB患者60例及健康体检者60例作为对照队列。采用实时荧光定量聚合酶链反应PCR检测所有研究对象基线期外周血miR-145-5p、miR-223表达水平,研究组患者在治疗3个月、6个月动态检测上述指标。比较研究组不同治疗应答及预后结局患者的miR-145-5p、miR-223表达水平,采用受试者工作特征(ROC)曲线分析miR-145-5p、miR-223表达水平对COPD合并PTB患者治疗应答的预测价值,采用多因素Logistic回归分析COPD合并PTB患者预后的影响因素。结果? 研究组基线期外周血 miR-145-5p表达水平显著低于COPD 组、PTB组及健康对照组(P<0.05),miR-223表达水平显著高于上述三组(P<0.05)。治疗6个月后,研究组中治疗有效126例(有效组),治疗无效54例(无效组)；有效组治疗后各时间节点miR-145-5p表达水平逐渐升高,miR-223表达水平逐渐降低(P<0.05),无效组上述指标无明显变化(P>0.05)。基线期miR-145-5p联合miR-223预测治疗应答的曲线下面积(AUC)为0.842(95% CI:0.778~0.905),灵敏度88.1%,特异度78.3%,优于单一指标。2年随访期间,研究组复发28例,死亡16例,预后不良组(复发或死亡)基线期miR-145-5p表达更低、miR-223表达更高(P<0.05)。多因素Logistic回归分析显示,基线期miR-145-5p低表达、miR-223高表达、肺结核病灶范围(多肺叶)、IL-6及CRP水平升高是COPD合并PTB患者预后不良的独立危险因素(P<0.05)。结论? COPD合并PTB患者外周血miR-145-5p呈低表达、miR-223呈高表达,二者联合检测可作为评估患者治疗应答及预后的潜在生物标志物,为临床个体化治疗及预后管理提供参考。

  关键词： 慢性阻塞性肺疾病; 肺结核; 微小RNA-145-5p; 微小RNA-223; 治疗应答; 预后

   

  Abstract: Objective? To investigate the correlation between the expression levels of peripheral blood microRNA-145-5p (miR-145-5p) and microRNA-223 (miR-223) and treatment response and prognosis in patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary tuberculosis (PTB).Methods? A total of 180 patients with COPD complicated with PTB treated in this hospital from March 2022 to March 2024 were enrolled as the study group. Meanwhile, 60 COPD patients, 60 PTB patients and 60 healthy subjects during the same period were selected as the control cohort. Quantitative real-time polymerase chain reaction (qRT-PCR) was applied to detect the baseline expression levels of peripheral blood miR-145-5p and miR-223 in all subjects, and the above indicators were dynamically measured in the study group at 3 and 6 months of treatment. The expression levels of miR-145-5p and miR-223 were compared among patients with different treatment responses and prognostic outcomes in the study group. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of miR-145-5p and miR-223 expression levels for treatment response in patients with COPD complicated with PTB. Multivariate Logistic regression analysis was performed to explore the influencing factors for prognosis in these patients.Results? The baseline expression level of peripheral blood miR-145-5p in the study group was significantly lower than that in the COPD group, PTB group and healthy control group (P<0.05), while the expression level of miR-223 was significantly higher than that in the three groups above (P<0.05). After 6 months of treatment, 126 patients in the study group achieved effective treatment (effective group) and 54 had ineffective treatment (ineffective group). In the effective group, the expression level of miR-145-5p gradually increased and that of miR-223 gradually decreased at each time point after treatment (P<0.05), whereas no significant changes were found in the above indicators in the ineffective group (P>0.05). The area under the ROC curve (AUC) of baseline miR-145-5p combined with miR-223 for predicting treatment response was 0.842 (95% CI: 0.778~0.905), with a sensitivity of 88.1% and a specificity of 78.3%, which was superior to single indicator detection. During the 2-year follow-up, 28 patients in the study group experienced recurrence and 16 died. The poor prognosis group (recurrence or death) showed lower baseline miR-145-5p expression and higher miR-223 expression (P<0.05). Multivariate Logistic regression analysis revealed that low baseline expression of miR-145-5p, high baseline expression of miR-223, multi-lobe pulmonary tuberculosis lesion extent, elevated interleukin-6 (IL-6) and C-reactive protein (CRP) levels were independent risk factors for poor prognosis in patients with COPD complicated with PTB (P<0.05).Conclusion? Peripheral blood miR-145-5p is down-regulated and miR-223 is up-regulated in patients with COPD complicated with PTB. Combined detection of the two can serve as potential biomarkers for evaluating treatment response and prognosis of such patients, providing a reference for clinical individualized treatment and prognosis management.

  Key words: chronic obstructive pulmonary disease; pulmonary tuberculosis; microRNA-145-5p; microRNA-223; treatment response; prognosis

  提交时间：2026-04-27

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• 序号	提交日期	编号	操作
  1	2026-04-10	10.12201/bmr.202604.00163V1	下载

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