急性白血病并发脓毒症患者可溶性CD40/CD40L水平及CD40 rs1883832多态性

Soluble CD40/CD40L level and CD40 rs1883832 polymorphism of acute leukemia patients complicated with sepsis

目的探讨可溶性CD40/CD40L(sCD40/sCD40L)水平及CD40 rs1883832多态性与白血病患者化疗脓毒症感染相关性。方法选择上海市瑞金医院2017年3月-2020年3月收治急性白血病并发脓毒症患者60例作为脓毒症组,选择同期医院进行化疗的急性白血病患者40例作为非脓毒症组,采用DNA测序法检测CD40基因rs1883832位点多态性,采用酶联免疫吸附法(ELISA)检测血清sCD40、sCD40L水平。结果脓毒症组CD40基因rs1883832 CC、CT、TT基因型频率分别为18.33%、50.00%、31.67%,其中CC型低于非脓毒症组(P<0.05);脓毒症组T基因型频率高于、C基因型低于非脓毒症组(P<0.05);脓毒症组TT型sCD40、sCD40L水平高于CT型及CC型(P<0.05),CT型sCD40、sCD40L水平高于CC型(P<0.05);死亡患者TT基因型频率、血清sCD40、sCD40L水平高于存活患者,CC基因型频率低于存活患者(P<0.05)。结论 CD40基因rs1883832位点多态性可能与急性白血病患者并发脓毒症易感性及预后有关,T基因可能为易感基因,C基因为保护基因,sCD40、sCD40L水平对于判断患者预后具有一定的价值,其机制有待研究。

OBJECTIVE To explore the relationship between soluble CD40/CD40 L(soluble CD40/CD40 L, sCD40/sCD40 L) level and the polymorphism of CD40 rs1883832 and chemotherapy sepsis infection in leukemia patients. METHODS All 60 patients with acute leukemia complicated with sepsis admitted to Shanghai Ruijin Hospital from Mar. 2017 to Mar. 2020 were recruited as the sepsis group, and 40 patients with acute leukemia undergoing chemotherapy in the same hospital were enrolled as the non-sepsis group. The CD40 gene rs1883832 polymorphism was detected by DNA sequencing, and the serum sCD40 and sCD40 L levels were detected by enzyme-linked immunosorbent assay(ELISA). RESULTS The frequency of CD40 gene rs1883832 CC, CT, and TT genotypes in the study group were 18.33%, 50.00% and 31.67%, respectively. The frequency of CC type in the study group was significantly lower than that in the non-sepsis group(P<0.05). The frequency of the T genotype in the sepsis group is significantly higher, but the C genotype is significantly lower than that in the non-sepsis group(P<0.05);the TT type sCD40 and sCD40 L levels are significantly higher than the CT type and CC type levels in the sepsis group(P<0.05), and the CT type sCD40 and sCD40 L levels was significantly higher than that of type CC(P<0.05);the frequency of TT genotype, serum sCD40 and sCD40 L levels in dead patients were significantly higher, but the frequency of CC genotype was lower than that in surviving patients(P<0.05). CONCLUSION CD40 rs1883832 polymorphism may be related to the susceptibility to sepsis in patients with acute leukemia. The T allele may be susceptible and the C allele may be protectable. The levels of sCD40 and sCD40 L have a certain value in judging the prognosis of patients. Its mechanism should be studied.