外周血单核细胞NLRP3炎性小体对脓毒症急性肺损伤患者病情严重程度的诊断价值

Diagnostic value of NLRP3 inflammatory corpuscles in peripheral blood mononuclear cells in sepsis patients with acute lung injury

目的探讨外周血单核细胞中NLRP3炎性小体对脓毒症急性肺损伤患者病情严重程度的诊断价值。方法采用qRT⁃PCR、Western⁃Blot检测脓毒症急性肺损伤患者外周血单核细胞中NLRP3、Caspase⁃1的mRNA及蛋白表达;酶联免疫吸附法检测相关细胞因子(IL⁃1β、IL⁃18)水平并比较不同严重程度及预后组间的差异,评价NLRP3水平对患者病情严重程度的预测价值。结果不同严重程度APACHEⅡ和LIPS评分、外周血单核细胞NLRP3、Caspase⁃1表达水平及外周血IL⁃1β及IL⁃18水平比较,高危组上述指标水平最高,中危组次之,低危组最低,(P<0.05)。死亡组患者NLRP3和Caspase⁃1 mRNA表达水平和外周血IL⁃1β和IL⁃18水平明显高于存活组(P<0.05)。ROC曲线分析显示,NLRP3 mRNA水平曲线下面积为0.877(95%CI:0.808~0.946),其最佳工作点为2.68,此时预测脓毒症急性肺损伤患者病情严重程度的敏感性和特异性分别为82.05%和78.87%,均显著优于LIPS评分和APACHEⅡ评分指标。结论NLRP3炎性小体参与了脓毒症急性肺损伤患者的炎症级联放大,对于脓毒症急性肺损伤患者病情严重程度的预测,具有一定的应用价值。

Objective To investigate the diagnostic value of NLRP3 inflammatory corpuscles in peripheral blood mononuclear cells in sepsis patients with acute lung injury.Methods The mRNA and protein expression levels of NLRP3 and Caspase⁃1 in mononuclear cells were measured by qRT⁃PCR and Western⁃blot.The levels of related cytokines(IL⁃1βand IL⁃18)were detected by ELISA.The differences of the above indicators were compared in different severity groups and different prognostic groups,and the predictive value of NLRP3 was evaluated on the severity of sepsis patients with acute lung injury.Results APACHEⅡscore,LIPS score,NLRP3 and Caspase⁃1 expression level,and the levels of IL⁃1βand IL⁃18 in peripheral blood in the high⁃risk group was the highest,followed by that in the middle⁃risk group and the low⁃risk group.The expression of NLRP3,Caspase⁃1 and the levels of IL⁃1βand IL⁃18 in peripheral blood were significantly higher in death group than those in the survival group(P<0.05).ROC curves analysis showed that the area under curve of NLRP3 was 0.877(95%CI:0.808~0.946),and optimal operating point(OOP)2.68,with a sensitivity of 82.05%and a specificity of 78.87%in predicting the severity of sepsis patients with acute lung injury,which was significantly better than those of LIPS and APACHEⅡscore.Conclusion NLTP3 inflammatory corpuscle is involved in the inflammatory cascade ampli⁃fication of sepsis patients with acute lung injury,which has important clinical value for predicting the severity of sepsis with acute lung injury.