SIRT2对脓毒症进展为持续炎症-免疫抑制-分解代谢综合征的预测价值探讨

Predictive value of SIRT2 in the progression of sepsis to persistent inflammation-immunosuppression and catabolism syndrome

目的探讨SIRT2对脓毒症进展为持续炎症-免疫抑制-分解代谢综合征(persistent inflammation-immunosuppression and catabolism syndrome,PICS)的预测价值。方法纳入2018年6月到2019年6月收住在天津市第一中心医院重症监护病房的脓毒症患者81例,募集20例健康成年志愿者做为对照。筛选出住院时间超过14 d的患者45例,分为非PICS组和PICS组。采集入院0 h、24 h、4 d、7 d、10 d、14 d、17 d、21 d共8个时间点的血标本(对照组于清晨空腹仅抽取1次),测定不同时间点SIRT2、PD-1、TNF-α、IL-6、IL-10、TGF-β水平。绘制受试者工作特征曲线,计算曲线下面积,评价SIRT2和PD-1对脓毒症进展为PICS的预测价值。结果①非PICS组与PICS组入院时SIRT2和PD-1表达均较对照组低,与非PICS组比较,PICS组SIRT2和PD-1表达先后在10 d及14 d呈升高趋势,两组10 d时SIRT2表达差异有统计学意义(P<0.05),分别为(0.87±0.08)、(1.15±0.09),两组14 d时PD-1表达差异有统计学意义(P<0.05),分别为(0.86±0.04)、(1.01±0.02);②随时间推移,非PICS组与PICS组TNF-α、IL-6呈下降趋势,PICS组IL-10、TGF-β在10 d后先后高于非PICS组(P<0.05)。③PD-1的曲线下面积为0.766(95%CI:0.624~0.908),截断值为1.01时,灵敏度70.8%,特异度81.0%;SIRT2的AUC为0.841(95%CI:0.722~0.960),截断值为1.10时,灵敏度79.2%,特异度81.0%。结论脓毒症患者进入PICS阶段时SIRT2表达水平发生改变;SIRT2对PICS的发生具有一定的预测价值。

Objective To explore the predictive value of SIRT2 in the progression of sepsis to persistent inflammation-immunosuppression and catabolism syndrome(PICS).Methods From June 2018 to June 2019,81 sepsis patients in Intensive Care Unit of Tianjin First Center Hospital were enrolled,and 20 healthy adult volunteers were recruited as controls.Forty-five patients who had been hospitalized for more than 14 d were selected and divided into the non-PICS group and PICS group.Blood samples were collected at 0,24 h,4 d,7 d,10 d,14 d,17 d,and 21 d.The levels of SIRT2,PD-1,TNF-α,IL-6,IL-10 and TGF-βwere measured at different time points.In the control group,and fasting was taken only once in the morning.ROC curve was drawn and AUC was calculated to evaluate the value of SIRT2 and PD-1 in predicting sepsis progression to PICS.Results(1)Compared with the control group,the expression of SIRT2 and PD-1 decreased at admission in the non-PICS group and PICS group(P<0.05).Compared with the non-PICS group,the expression of SIRT2 and PD-1 in the PICS group increased at 10 and 14 d,respectively.SIRT2 in the PICS group had statistical difference at 10 d[(0.87±0.08)and(1.15±0.09),respectively;P<0.05].PD-1 was statistical difference at 14 d between the two groups[(0.86±0.04)and(1.01±0.02),respectively;P<0.05].(2)Over time,TNF-αand IL-6 in the two groups declined gradually,but IL-10 and TGF-βin the PICS group were higher than those in the non-PICS group at 10 d(P<0.05).(3)The AUC of PD-1 was 0.766(95%CI:0.624-0.908),and the sensitivity and specificity were 70.8%and 81.0%,when the cut-off value was 1.01.The AUC of SIRT 2 was 0.841(95%CI:0.722-0.960),and the sensitivity and specificity were 79.2%and 81.0%,when the cut-off value was 1.10.Conclusions SIRT2 expression level changes when sepsis patients enter PICS stage.SIRT2 has certain predictive value for the occurrence of PICS.