急性百草枯中毒患者血清程序性死亡因子1水平变化及与肺纤维化的相关性

Changes of serum programmed death-1 level in patients with acute paraquat poisoning and its correlation with pulmonary fibrosis

目的探究急性百草枯中毒患者血清程序性死亡因子1(PD-1)水平变化及与肺纤维化的相关性。方法选取2018年6月至2019年6月空军军医大学第二附属医院诊治的急性百草枯口服中毒患者30例(观察组),另选取本院同期体检健康者37名为对照组。观察组于服毒后24、48、72 h进行血清PD-1其配体(PD-L1)水平检测,服毒后48 h行动脉血气分析和肝肾功能检测,服毒后72 h行胸部高分辨CT检查,记录肺正常密度容积百分比,并进行肺纤维化、急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)、改良版英国医学研究委员会呼吸困难量表(mMRC)评估,记录其评分。对照组研究对象均于体检合格后统一进行上述指标评估。比较2组研究对象上述指标水平,分析急性百草枯中毒患者服毒后72 h血清PD-1和PD-L1水平与肺纤维化指标水平及mMRC、APACHEⅡ评分的相关性。结果观察组服毒后24、48、72 h血清PD-1和PD-L1水平均高于对照组[(68±18)、(74±12)、(86±20)μg/L比(52±14)μg/L,(0.51±0.16)、(0.76±0.20)、(0.89±0.24)μg/L比(0.37±0.05)μg/L],且随着服毒时间延长血清PD-1和PD-L1水平逐渐升高(均P<0.05);服毒后48 h动脉血氧分压、动脉血二氧化碳分压和pH值均低于对照组,血清丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶、尿素氮和肌酐水平均高于对照组(均P<0.05);服毒后72 h肺纤维化评分、mMRC评分和APACHEⅡ评分均高于对照组,肺正常密度容积百分比低于对照组(均P<0.05)。Pearson相关性分析结果表明,急性百草枯中毒患者服毒后72 h血清PD-1和PD-L1水平与肺纤维化评分、mMRC评分和APACHEⅡ评分均呈正相关,与CT肺正常密度容积百分比均呈负相关(均P<0.05)。结论急性百草枯中毒患者血清PD-1和PD-L1表达水平升高,且服毒后72 h其表达水平与患者肺纤维化严重程度密切相关。

Objective To explore the changes of serum programmed death-1(PD-1)level and its correlation with pulmonary fibrosis in patients with acute paraquat poisoning.Methods From June 2018 to June 2019,30 patients with acute paraquat oral poisoning in the Second Affiliated Hospital of Air Force Medical University were selected as the observation group,and 37 healthy people underwent physical examination in the same period in the hospital were selected as the control group.In the observation group,serum PD-1 and PD ligand-1(PD-L1)levels were detected at 24,48 and 72 h after poisoning,arterial blood gas analysis,liver and kidney function tests were performed at 48 h after poisoning,lung high-resolution CT examination was performed at 72 h after poisoning,and the lung normal density volume percentage was recorded.The scores of pulmonary fibrosis,acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ)and modified British Medical Research Council scale(mMRC)were evaluated and recorded.Above indexes of subjects in control group were detected after physical examination qualified,and those were compared between the two groups.The correlation between serum PD-1,PD-L1 levels and pulmonary fibrosis index levels,as well as mMRC and APACHEⅡscores in patients with acute paraquat poisoning was analyzed.Results At 24,48 and 72 h after poisoning,the serum levels of PD-1 and PD-L1 in the observation group were higher than those in the control group[(68±18),(74±12),(86±20)μg/L vs(52±14)μg/L;(0.51±0.16),(0.76±0.20),(0.89±0.24)μg/L vs(0.37±0.05)μg/L],and the serum levels of PD-1 and PD-L1 gradually increased with the prolongation of poisoning time(all P<0.05).The arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide and pH value in the observation group were lower than those in the control group 48 h after poisoning,and the surem levels of alanine aminotransferase,aspartate aminotransferase,gamma glutamyl transferase,urea nitrogen and creatinine in the observation group were higher than those in the control group(all P<0.05).At 72 h after poisoing,pulmonary fibrosis score,mMRC score and APACHEⅡscore of the observation group were higher than those of the control group,and the CT lung normal density volume percentage of the observation group was lower than that of the control group(all P<0.05).Pearson correlation analysis showed that serum PD-1 and PD-L1 levels were positively correlated with pulmonary fibrosis score,mMRC score and APHCHEⅡscore,but negatively correlated with CT lung normal density volume percentage(all P<0.05).Conclusion The expression levels of PD-1 and PD-L1 in patients with acute paraquat poisoning are increased,and their expression levels are closely related to the severity of pulmonary fibrosis.