核转录因子-κB及其抑制因子mRNA表达对多器官功能障碍综合征预后判断的作用

Evaluation of nuclear factor-κB and IκB mRNA expression in determining the prognosis of multiple organ dysfunction syndrome

目的观察核转录因子-κB（NF-κB）及其抑制因子（IκB）的mRNA表达水平在多器官障碍综合征（MODS）患者预后评估中的作用。方法将43例MODS患者按预后分为存活组（28例）和死亡组（15例），选择同期10例健康体检者作为对照。于入院当日使用逆转录-聚合酶链反应（RT—PCR）测定血中单核／粒细胞NF-κB mRNA及IκB-α mRNA的表达水平，并比较存活组与死亡组各项数值。结果MODS患者NF-κB mRNA表达水平明显高于正常对照组（1．35±0．53比0．74±0．25，P〈0．01），而IκB-α mRNA表达水平明显低于正常对照组（1．24±0．60比1．97±0．71，P〈0．01）。死亡组NF—κB mRNA表达水平与存活组比较差异无统计学意义（1．27±0．37比1．39±0．60，P〉0．05），而IκB-α mRNA表达水平则明显低于存活组（0．94±0．46比1．40±0．61，P〈O．05）。相关分析显示，IκB-α mRNA表达水平与急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分呈明显负相关（r=-0．340，P〈0．05）；且当IκB-α mRNA表达水平截断点为1．34时，其约登指数在各截断点中最高，为0．51，特异度为90．72％，敏感度为60．75％。结论IκB mRNA表达水平可用来判断MODS患者的预后。

Objective To observe the value of nuclear factor-κB（NF-κB） and IκB mRNA expression estimation on determining the prognosis of patients with multiple organ dysfunction syndrome （MODS）. Methods Forty-three MODS patients were divided into two groups based on their prognosis： the survivor group （n=28） and the non-survivor group （n=15）. Another group of 10 healthy persons served as normal control group. The expression of NF-κB and IκB a mRNA levels in monocytes/neutrophiles of patients and controls were detected by reverse transcription polymerase reaction （RT-PCR）, and the results were compared among groups. Results The expression of NF-κB mRNA levels of MODS patients was higher than that of normal control group （1.35 ± 0.53 vs. 0. 74 ± 0. 25, P〈 0.01）, and the expression of IκB-α mRNA levels were lower than those of the control group （1. 24±0.60 vs. 1. 97±0. 71,P〈0. 01）. There was no significant difference in NF-κB mRNA levels between the survivor group and the non-survivor group （1.27 ± 0.37 vs. 1.39 ± 0. 60, P〉 0. 05）, but the expression of IκB-α mRNA levels in the non-survivor group was significantly lower than that of survivors （0. 94± 0. 46 vs. 1. 40± 0. 61, P〈0.05）. The results suggested that there was a negative correlation between the expression of IκB-α mRNA level and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） （r=-0. 340, P〈0.05）. Moreover, when the cutoff value of the expression of IκB-α mRNA level was 1.34, the Youden index was 0.51, and it was the highest in all the cutoff values, and the specificity was 90. 72% ,the sensitivity was 60.75%. Conclusion The expression of IκB-α mRNA level can be a useful guide for determining the prognosis of patients with MODS.