目的：探讨分析血清中微小RNA-330-5p（miR-330-5p）、微小RNA-140-5p（miR-140-5p）和微小RNA-214-5p（miR-214-5p）表达对脓毒症伴有急性肾损伤（AKI）患者预后的评估价值。方法：选取2022年1月至2024年1月唐山职业技术学院附属医院收治的186例脓毒症AKI患者、186例单纯脓毒症患者及同期186例健康体检志愿者为研究对象，分别纳入AKI组、非AKI组和健康组。AKI组治疗28 d内存活115例（纳入生存组），死亡71例（纳入死亡组）。采用qRT-PCR法检测三组研究对象血清中miR-330-5p、miR-140-5p、miR-214-5p表达；Spearman法分析miR-330-5p、miR-140-5p、miR-214-5p与APACHE Ⅱ评分、SOFA评分的相关性；多因素Logistic回归模型分析脓毒症伴有AKI患者治疗28 d内死亡的影响因素；ROC曲线分析miR-330-5p、miR-140-5p、miR-214-5p评估脓毒症伴有AKI患者治疗28 d内死亡的预后价值。结果：AKI组患者血清miR-330-5p、miR-140-5p水平低于非AKI组和健康组，miR-214-5p水平高于非AKI组和健康组（P＜0.05）。AKI 1期、2期、3期患者血清miR-330-5p、miR-140-5p水平呈下降趋势，miR-214-5p水平呈上升趋势（P＜0.05）。死亡组APACHE Ⅱ评分、SOFA评分、PCT及miR-214-5p水平高于生存组，氧合指数、miR-330-5p、miR-140-5p水平低于生存组（P＜0.05）。AKI组患者miR-330-5p、miR-140-5p与APACHE Ⅱ评分、SOFA评分呈负相关，miR-214-5p与APACHE Ⅱ评分、SOFA评分呈正相关（P＜0.05）。氧合指数、miR-330-5p、miR-140-5p为保护因素，APACHE Ⅱ评分、SOFA评分及PCT、miR-214-5p为危险因素（P＜0.05）。miR-330-5p、miR-140-5p、miR-214-5p预测脓毒症伴有AKI患者死亡的曲线下面积（AUC）分别为0.839、0.827、0.844，三者联合预测的AUC为0.927，优于miR-330-5p、miR-140-5p、miR-214-5p单独预测的AUC（ZmiR-330-5p=2.601，ZmiR-140-5p=2.750，ZmiR-214-5p=2.230，P＜0.05）。结论：脓毒症伴有AKI患者血清miR-330-5p、miR-140-5p水平均下调表达，miR-214-5p上调表达，三者与患者预后密切相关，三者联合可有效预测脓毒症伴有AKI患者预后死亡。

Objective: To explore and analyze the prognostic value of serum expression of microRNA-330-5p (miR-330-5p), microRNA-140-5p (miR-140-5p), and microRNA-214-5p (miR-214-5p) in patients with sepsis acute kidney injury (AKI). Methods: A total of 186 patients with sepsis-induced AKI, 186 patients with sepsis alone, and 186 healthy volunteers who underwent physical examinations during the same period were selected from Affiliated Hospital of Tangshan Vocational and Technical College from January 2022 to January 2024 as the research subjects and were respectively included in the AKI group, the non-AKI group, and the healthy group. Among the AKI group, 115 cases survived within 28 days of treatment (included in the survival group), and 71 cases died (included in the death group). The expression levels of miR-330-5p, miR-140-5p, and miR-214-5p in the serum of the three groups were detected by qRT-PCR; the correlations between miR-330-5p, miR-140-5p, miR-214-5p and APACHE Ⅱ score, SOFA score were analyzed by Spearman method. Multivariate logistic regression model was applied to analyze the influencing factors of death within 28 days of treatment in sepsis AKI patients. ROC curve was applied to analyze the prognostic value of miR-330-5p, miR-140-5p, and miR-214-5p in evaluating death within 28 days of treatment in sepsis AKI patients. Results: The levels of serum miR-330-5p and miR-140-5p in AKI patients were lower than those in non-AKI patients and healthy individuals, while the level of miR-214-5p was higher (P<0.05). The levels of serum miR-330-5p and miR-140-5p in AKI patients at stage 1, 2, and 3 showed a decreasing trend, while the level of miR-214-5p showed an increasing trend (P<0.05). The APACHE II score, SOFA score, PCT, and miR-214-5p level in the death group were higher than those in the survival group, while the oxygenation index, miR-330-5p, and miR-140-5p levels were lower (P<0.05). In AKI patients, miR-330-5p and miR-140-5p were negatively correlated with the APACHE II score and SOFA score, while miR-214-5p was positively correlated with them (P<0.05). The oxygenation index, miR-330-5p, and miR-140-5p were protective factors, while the APACHE II score, SOFA score, PCT, and miR-214-5p were risk factors (P<0.05). The area under the curve (AUC) for predicting death in sepsis patients with AKI by miR-330-5p, miR-140-5p, and miR-214-5p was 0.839, 0.827, and 0.844, respectively. The AUC for the combined prediction of the three was 0.927, which was superior to the AUC of the individual predictions of miR-330-5p, miR-140-5p, and miR-214-5p (ZmiR-330-5p=2.601, ZmiR-140-5p=2.750, ZmiR-214-5p=2.230, P<0.05). Conclusion: Serum miR-330-5p and miR-140-5p are down-regulated in patients with sepsis accompanied by AKI, while miR-214-5p is up-regulated. The three are closely related to patient prognosis, and their combination can effectively predict prognosis and death in patients with sepsis accompanied by AKI.