脓毒症患者外周血淋巴细胞自噬相关基因 Beclin-1和LC3的变化研究

Study on the changes of Beclin-1 and LC3 related to autophagy in peripheral blood lymphocytes of patients with sepsis

目的观察脓毒症患者外周血淋巴细胞自噬的变化,并探讨其临床意义。方法选取10例健康人、20例普通感染患者和20例脓毒症患者,分别设为H组、I组和S组,根据预后再将S组亚组分析分为存活组(14例)和死亡组(6例),收集年龄、性别、感染部位、原发病、白细胞(WBC)、血小板(PLT)、谷丙转氨酶(ALT)、肌酐(Cr)、白蛋白、血糖和APACHEⅡ评分等资料,同时抽取外周血分离淋巴细胞,检测Beclin-1和LC3 mRNA相对表达量。结果 3组年龄、性别、原发病和感染部位比较差异无统计学意义(均P>0.05),3组WBC、PLT、ALT、Cr、白蛋白和血糖比较差异有统计学意义(均P<0.01);I组和S组APACHEⅡ评分比较差异有统计学意义(P<0.01);3组外周血淋巴细胞中Beclin-1和LC3 mRNA的相对表达量比较差异有统计学意义(均P<0.01),存活组和死亡组之间Beclin-1和LC3 mRNA的相对表达量比较差异有统计学意义(均P<0.01);APACHEⅡ评分与Beclin-1具有线性负相关(r=-0.452,P<0.001),APACHEⅡ评分与Beclin-1之间的线性模型方程式:Y=-20.83+41.67X;APACHEⅡ评分与LC3具有线性负相关(r=-0.641,P<0.001),APACHEⅡ评分与LC3之间的线性模型方程式:Y=-6.25+62.5X。在诊断脓毒症方面,Beclin-1:ROC曲线下面积为0.791,标准误为0.070,P<0.001,LC3:ROC曲线下面积为0.851,标准误为0.066,P<0.001。结论脓毒症外周血淋巴细胞自噬水平明显降低,可以反映脓毒症的免疫状态,并且在临床上可以作为普通感染和脓毒症的判断指标,为脓毒症诊断提供新思路。

Objective To observe the changes of autophagy of peripheral blood lymphocytes in patients with sepsis and explore its clinical significance. Methods Total 10 healthy people, 20 patients with common infection and 20 patients with sepsis were divided into H group, I group and S group. According to the prognosis, the S group was divided into survival group(14 cases) and death group(6 cases). General data, WBC, PLT, ALT, Cr, albumin, blood glucose and APACHE Ⅱ scores were collected. Meanwhile, lymphocytes were isolated from venous blood to detect the relative expression of Beclin-1 and LC3 mRNA. Results There were no significant differences in age, gender, primary disease and infection site among the three groups(all P>0.05), but there were significant differences in WBC, PLT, alt, Cr, albumin and blood glucose(all P<0.01). There was significant difference in APACHE Ⅱ score between I group and S group(P<0.01). There was significant difference in the relative expression of Beclin-1 and LC3 mRNA between the three groups(all P<0.01). There was significant difference in the relative expression of Beclin-1 and LC3 mRNA between the survival group and the death group(all P<0.01). There was a linear negative correlation between APACHE Ⅱ score and Beclin-1(r=-0.452, P<0.001), and the linear model equation between APACHE Ⅱ score and Beclin-1 was Y=-20.83+41.67 X. There was a linear negative correlation between APACHE Ⅱ score and LC3(r=-0.641, P<0.001), and the linear model equation between APACHE Ⅱ score and Beclin-1 was Y=-6.25+62.5 X. In the diagnosis of sepsis, Beclin-1: area under ROC curve was 0.791, standard error was 0.070(P<0.001);LC3: area under ROC curve was 0.851, standard error was 0.066(P<0.001). Conclusion The autophagy level of venous blood lymphocytes in patients with sepsis is significantly reduced, which can reflect the immune status of sepsis and provide a new way for the diagnosis of sepsis.