外周血单个核细胞NLRP3的表达与脓毒症急性肾损伤发生及进展的相关性分析

Correlation analysis between the expression of NLRP3 in peripheral blood mononuclear cells and the occurrence and progression of sepsis with acute kidney injury

目的探讨外周血单个核细胞核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)的表达与脓毒症急性肾损伤发生及进展的相关性。方法选取2016年2月至2020年1月重庆市綦江区人民医院收治的普通脓毒症患者为普通脓毒症组(55例)及脓毒症急性肾损伤患者为脓毒症急性肾损伤组(154例),另选取同期体检健康者50例为对照组。采用qRT-PCR检测各组单个核细胞中NLRP3、半胱氨酸蛋白酶-1(Caspase-1)的mRNA相对表达水平;采用酶联免疫吸附试验(ELISA)检测相关炎性因子[白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)]水平,分别比较各组上述指标的差异。结果脓毒症急性肾损伤组NLRP3 mRNA、Caspase-1 mRNA、IL-1β及TNF-α水平较对照组和普通脓毒症组明显升高(P<0.05)。脓毒症急性肾损伤不同分期组间上述指标及肌酐(Cr)水平比较,Ⅲ期组最高,Ⅱ期组次之,Ⅰ期组最低(P<0.05);死亡组上述指标明显高于存活组(P<0.05)。脓毒症急性肾损伤患者NLRP3 mRNA相对表达水平分别与Caspase-1 mRNA、IL-1β、TNF-α及Cr水平呈正相关(r=0.802、0.720、0.621、0.633,P<0.05)。受试者工作特征(ROC)曲线分析显示,NLRP3 mRNA相对表达水平区分脓毒症急性肾损伤组存活和死亡的曲线下面积(AUC)明显大于Cr、Caspase-1 mRNA、IL-1β和TNF-α(P<0.05)。结论NLRP3参与了脓毒症急性肾损伤的发生、发展过程,对于脓毒症急性肾损伤患者预后的评估,具有一定的应用价值。

Objective To investigate the correlation between the expression of nucleotide-binding oligomeric domain-like receptor protein 3(NLRP3)in peripheral blood mononuclear cells and the occurrence and progression sepsis patients with acute lung injury.Methods The general sepsis patients(55 cases)and sepsis patients with acute kidney injury(154 cases)admitted in People′s Hospital of Qijiang District were enrolled in the study,and healthy subjects(50 cases)in the same period were selected as the control group.The mRNA relative expression of NLRP3 and Caspase-1 in mononuclear cells were measured by qRT-PCR.The levels of related inflammatory factors interleukin-1β(IL-1β),tumor necrosis factorα(TNF-α)were detected by enzyme linked immuno sorbent assay(ELISA).The differences of the above indicators were compared.Results Compared with the control group and the general sepsis group,the levels of NLRP3 mRNA,Caspase-1 mRNA,IL-1βand TNF-αin sepsis patients with acute kidney injury were significantly increased(P<0.05).The levels of the above indicators and creatinine(Cr)in different stages of sepsis with acute kidney injury were compared,the stageⅢgroup was the highest,the stageⅡgroup was the second,and the stageⅠgroup was the lowest(P<0.05).The levels of the above indicators were significantly higher in death group than the survival group(P<0.05).The correlation analysis showed that there were significant positive correlation among the relative expression of NLRP3 mRNA in peripheral blood and Caspase-1 mRNA,IL-1β,TNF-αand Cr levels(r=0.802,0.720,0.621,0.633,P<0.05).ROC curves analysis showed that the area under curve(AUC)of the NLRP3 mRNA in distinguishing surviving and non-surviving in sepsis patients with acute kidney injury was significantly greater than those of Cr,Caspase-1 mRNA,IL-1βand TNF-α(P<0.05).Conclusion NLTP3 is involved in the occurrence and development of sepsis with acute kidney injury,which has important clinical value for predicting the prognosis of sepsis with acute kidney injury.