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已发表论文
老年重症肺炎合并急性呼吸窘迫综合征患者血清 miR-27a 水平降低及 FOXO3 升高：与疾病严重程度及预后的关联
Authors Zhao P, Wang Z, Shi M, Zhou Y, Zhang Z, Fang X, Qu G
Received 12 July 2025
Accepted for publication 10 October 2025
Published 21 October 2025 Volume 2025:18 Pages 14465—14474
DOI https://doi.org/10.2147/JIR.S549833
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Yuhan Xing
Peng Zhao,1,* Zhiyan Wang,2,* Min Shi,2 Yu Zhou,3 Zhijian Zhang,2 Xiangqun Fang,2 Geping Qu2
1Health Management Center, Convalescent Zone 1, Hangzhou Special Service Convalescent Center of the Air Force of the People’s Liberation Army of China, Hangzhou, Zhejiang, 310007, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The Second Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, 100853, People’s Republic of China; 3The Laboratory Department of the Second Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Geping Qu, Email drqugp@163.com
Objective: To clarify the expression of microRNA-27a (miR-27a) and forkhead box protein O3 (FOXO3) in elderly patients with severe pneumonia complicated with acute respiratory distress syndrome (ARDS), and evaluate their relationship with disease severity and prognosis.
Methods: A total of 189 elderly patients with severe pneumonia were retrospectively analyzed, including 114 with ARDS (Group A) and 75 without ARDS (Group B). Seventy healthy individuals served as controls. Group A was further divided into mild (n=28), moderate (n=36), and severe (n=50) subgroups based on oxygenation index, and into survival (n=79) and death (n=35) subgroups based on 28-day outcome. Serum miR-27a and FOXO3 mRNA were measured by qRT-PCR. Their correlations with oxygenation index and prognosis were analyzed using Pearson, Spearman, logistic regression, and ROC curve methods.
Results: Serum miR-27a levels decreased and FOXO3 mRNA levels increased progressively from controls to Group B and Group A (F=77.352, 62.956, P< 0.001). Within Group A, miR-27a declined and FOXO3 rose stepwise with increasing ARDS severity (F=83.597, 111.834, P< 0.001). MiR-27a was negatively correlated with FOXO3 (r=− 0.624, P< 0.001), positively with oxygenation index (r=0.635, P< 0.001), while FOXO3 showed the opposite pattern (r=− 0.672, P< 0.001). The 28-day mortality was 30.7%. Logistic regression identified age, prolonged ventilation, and high FOXO3 as risk factors, while higher oxygenation index and elevated miR-27a were protective. The AUCs for mortality prediction were 0.775 (miR-27a), 0.781 (FOXO3), and 0.867 (combined).
Conclusion: Reduced miR-27a and elevated FOXO3 are characteristic of elderly patients with severe pneumonia and ARDS, closely linked to disease severity and prognosis. Combined detection improves predictive accuracy, supporting their potential as biomarkers for survival evaluation.
Keywords: miR-27a, FOXO3, severe pneumonia, ARDS, elderly, prognosis
1Health Management Center, Convalescent Zone 1, Hangzhou Special Service Convalescent Center of the Air Force of the People’s Liberation Army of China, Hangzhou, Zhejiang, 310007, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The Second Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, 100853, People’s Republic of China; 3The Laboratory Department of the Second Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Geping Qu, Email drqugp@163.com
Objective: To clarify the expression of microRNA-27a (miR-27a) and forkhead box protein O3 (FOXO3) in elderly patients with severe pneumonia complicated with acute respiratory distress syndrome (ARDS), and evaluate their relationship with disease severity and prognosis.
Methods: A total of 189 elderly patients with severe pneumonia were retrospectively analyzed, including 114 with ARDS (Group A) and 75 without ARDS (Group B). Seventy healthy individuals served as controls. Group A was further divided into mild (n=28), moderate (n=36), and severe (n=50) subgroups based on oxygenation index, and into survival (n=79) and death (n=35) subgroups based on 28-day outcome. Serum miR-27a and FOXO3 mRNA were measured by qRT-PCR. Their correlations with oxygenation index and prognosis were analyzed using Pearson, Spearman, logistic regression, and ROC curve methods.
Results: Serum miR-27a levels decreased and FOXO3 mRNA levels increased progressively from controls to Group B and Group A (F=77.352, 62.956, P< 0.001). Within Group A, miR-27a declined and FOXO3 rose stepwise with increasing ARDS severity (F=83.597, 111.834, P< 0.001). MiR-27a was negatively correlated with FOXO3 (r=− 0.624, P< 0.001), positively with oxygenation index (r=0.635, P< 0.001), while FOXO3 showed the opposite pattern (r=− 0.672, P< 0.001). The 28-day mortality was 30.7%. Logistic regression identified age, prolonged ventilation, and high FOXO3 as risk factors, while higher oxygenation index and elevated miR-27a were protective. The AUCs for mortality prediction were 0.775 (miR-27a), 0.781 (FOXO3), and 0.867 (combined).
Conclusion: Reduced miR-27a and elevated FOXO3 are characteristic of elderly patients with severe pneumonia and ARDS, closely linked to disease severity and prognosis. Combined detection improves predictive accuracy, supporting their potential as biomarkers for survival evaluation.
Keywords: miR-27a, FOXO3, severe pneumonia, ARDS, elderly, prognosis