脓毒症急性肺损伤患者血清CircAKRD36表达与炎症因子水平及预后相关

梅凯.脓毒症急性肺损伤患者血清CircAKRD36表达与炎症因子水平及预后相关[J].内科急危重症杂志,2024,30(5):412-417

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DOI：10.11768/nkjwzzzz.20240507

中文关键词: 脓毒症急性肺损伤环状RNA锚蛋白重复结构域36 炎症因子预后

英文关键词:

基金项目:四川省医学会科研课题项目（S20089）

作者	单位	E-mail
梅凯	成都市第五人民医院	lmlmlm20224@163.com

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中文摘要:

摘要目的：探讨脓毒症急性肺损伤患者血清环状RNA锚蛋白重复结构域36（CircANKRD36）表达与炎症因子水平及预后的关系。方法：收集脓毒症急性肺损伤住院患者112例为肺损伤组，根据28d生存状况分为死亡组（42例）和生存组（70例）；另选取同期收治的单纯脓毒症患者110例为脓毒症组。收集所有患者一般资料并进行比较。采用实时荧光定量聚合酶链反应（qRT-PCR）法检测血清CircANKRD36表达水平，采用酶联免疫吸附（ELISA）法检测血清炎症因子水平，采用Pearson相关性分析肺损伤组患者血清CircANKRD36与炎症因子水平的关系，采用多因素Logistic回归分析影响脓毒症急性肺损伤患者不良预后的危险因素，采用受试者工作特征（ROC）曲线分析血清CircANKRD36对脓毒症急性肺损伤患者不良预后的预测价值。结果：肺损伤组氧合指数（OI）低于脓毒症组，急性生理与慢性健康状况评估（APACHEⅡ）评分、序贯器官衰竭评估（SOFA）评分高于脓毒症组（P均＜0.05）；死亡组OI低于生存组，APACHEⅡ评分、SOFA评分、肺损伤预测评分（LIPS）高于生存组（P均＜0.05）。肺损伤组血清CircANKRD36、白介素（IL）-6、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、降钙素原（PCT）水平高于脓毒症组（P均＜0.05），死亡组血清CircANKRD36、IL-6、TNF-α、CRP、PCT水平高于生存组（P均＜0.05）。Pearson相关性分析显示，肺损伤组血清CircANKRD36与IL-6、TNF-α、CRP、PCT水平呈正相关（P均＜0.05）。多因素Logistic回归分析显示，低OI水平、高APACHEⅡ评分、高水平CircANKRD36、CRP、PCT是影响脓毒症急性肺损伤患者不良预后的危险因素（P均＜0.05）。血清CircANKRD36预测脓毒症急性肺损伤患者预后的曲线下面积（AUC）为0.836，其联合OI、APACHEⅡ评分、CRP、PCT共同预测的AUC为0.963，高于各项单独诊断。结论：脓毒症急性肺损伤患者血清CircANKRD36表达上调，与炎症因子水平及预后密切相关，可作为预后评估的生物标志物。

英文摘要:

Abstract Objective: To investigate the relationship between serum circular RNA ankyrin repeat domain 36 (CircANKRD36) and the levels of inflammatory factors, prognosis in patients with septic acute lung injury. Methods: Totally, 112 patients with septic acute lung injury were collected as the lung injury group. According to the 28-day follow-up, they were grouped into a death group of 42 cases and a survival group of 70 cases; another 110 patients with simple sepsis who were treated were regarded as the sepsis group. General data of all patients were collected and compared. The relative expression level of serum CircANKRD36 was detected by real-time quantitative PCR (qRT-PCR). Serum levels of inflammatory factors were detected by enzyme-linked immunosorbent assay (ELISA). Pearson correlation was applied to analyze the relationship between serum CircANKRD36 and inflammatory factor levels in patients in lung injury group. Multivariate logistic regression analysis was applied to analyze the risk factors for poor prognosis in patients with septic acute lung injury. Receiver operating characteristic (ROC) curve was applied to analyze the predictive value of serum CircANKRD36 for poor prognosis in patients with septic acute lung injury. Results: The oxygenation index(OI) in the lung injury group was lower than that in the sepsis group (P<0.05), and the APACHE II score and SOFA score in the lung injury group were higher than those in the sepsis group (all P<0.05); the OI of the death group was lower than that of the survival group, and the APACHE II score, SOFA score and LIPS score in the death group were higher than those in the survival group (all P<0.05). The levels of serum CircANKRD36, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and procalcitonin (PCT) in the lung injury group were higher than those in the sepsis group (all P<0.05).The levels of serum CircANKRD36, IL-6, TNF-α, CRP and PCT in the death group were higher than those in the survival group (all P<0.05). Pearson correlation analysis showed that serum CircANKRD36 in the lung injury group was positively correlated with IL-6, TNF-α, CRP, and PCT levels (all P<0.05). Multivariate Logistic regression analysis showed that low level of OI, high APACHE II score, high expressions of CircANKRD36, CRP and PCT were risk factors for poor prognosis in patients with septic acute lung injury (all P<0.05). The area under curve (AUC) of serum CircANKRD36 for predicting the prognosis of patients with acute lung injury in sepsis group was 0.836, the AUC predicted by the combination of OI, APACHEⅡ score, CRP and PCT was 0.963, which was higher than that of each single diagnosis. Conclusion: Serum CircANKRD36 expression is up-regulated in patients with septic acute lung injury, which is closely related to the level of inflammatory factors and prognosis of patients, and can be used as a biomarker for prognosis evaluation of patients with septic acute lung injury.