HSP70基因多态性与重症肺炎临床转归的关系

Association between HSP70 gene polymorphism and clinical treatment outcomes of severe pneumonia

目的研究热休克蛋白70(HSP70)基因多态性与重症肺炎(SP)临床转归的关系。方法以2016年1月-2020年7月江南大学附属医院103例SP患者为样本,检测外周血C-反应蛋白(CRP)、降钙素原(PCT)、血乳酸(Lac)和HSP70表达水平,同时分析HSP70-1+190 G/C、HSP70-2+1267A/G和HSP70-hom+2437T/C位点基因多态性,所有患者均给予抗感染、补液和营养支持等对症治疗,2周后评估治疗效果并根据结果将患者分为好转组68例和恶化组35例,比较两组临床资料和各项指标。结果恶化组SP患者年龄高于好转组(P<0.05),两组性别、体质量指数(BMI)、基础疾病和烟酒史比较,无统计学差异;恶化组SP患者HSP70表达水平低于好转组,CRP、PCT和Lac水平高于好转组,差异有统计学意义(P<0.05);恶化组SP患者HSP70-2+1267A/G位点等位基因A分布频率高于好转组(P<0.05),两组HSP70-1+190G/C和HSP70-hom+2437T/C位点基因型和等位基因分布频率比较,均无统计学差异;HSP70-2+1267A/G位点AA基因型患者CRP、PCT、Lac和HSP70表达水平高于AG型和GG型(P<0.05),两组HSP70-1+190G/C和HSP70-hom+2437T/C位点不同基因型患者CRP、PCT、Lac以及HSP70表达水平比较,无统计学差异。结论HSP70-2+1267A/G位点基因多态性和表达水平与SP患者炎症状态和临床转归存在密切联系,检测HSP70基因类型对评估疾病风险和指导治疗具有一定参考价值。

OBJECTIVE To observe the association between heat shock protein 70(HSP70 gene polymorphism and clinical treatment outcomes of severe pneumonia(SP).METHODS A total of 103 SP patients who were treated in the Affiliated Hospital of Jiangnan University from Jan 2016 to Jul 2020 were recruited as the study subjects.The expression levels of peripheral blood C-reactive protein(CRP),procalcitonin(PCT),lactic acid(Lac)and HSP70 were detected,the gene polymorphisms at HSP70-1+190 G/C,HSP70-2+1267 A/G and HSP70-hom+2437 T/C loci were analyzed,all of the patients were given symptomatic therapies such as anti-infection,fluid infusion and nutritional support.The patients were divided into the improvement group with 68 cases and the deterioration group with 35 cases according to the curative effects after the treatment for 2 weeks.The clinical data and indexes were compared between the two groups.RESULTS The SP patients of the deterioration group were significantly older than those of improvement group(P<0.05).There were no significant differences in gender,body mass index(BMI),underlying diseases and history of smoking and drinking between the two groups.The expression level of HSP70 of the SP patients was significantly lower in the deterioration group than in the improvement group,the levels of CRP,PCT and Lac of the deterioration group were significantly higher than those of the improvement group(P<0.05).The frequency of allele A at HSP70-2+1267 A/G locus of the SP patients was significantly higher in the deterioration group than in the improvement group(P<0.05).There were no significant differences in the frequencies of genotypes and alleles at HSP70-1+190 G/C and HSP70-hom+2437 T/C loci between the two groups.The expression levels of CRP,PCT,Lac and HSP70 of the patients with genotype AA at HSP70-2+1267 A/G locus were significantly higher than those of the patients with genotype AG and GG(P<0.05).There were no significant differences in the expression levels of CRP,PCT,Lac and HSP70 of the patients with different genotypes at HSP70-1+190 G/C and HSP70-hom+2437 T/C loci between the two groups.CONCLUSION The gene polymorphisms at HSP70-2+1267 A/G locus and expression levels are closely associated with the inflammatory state and clinical treatment outcomes of the SP patients.The genotype of HSP70 has certain value in assessment of risk of disease and guidance of treatment.