重症肺炎患者外周血NLRP3炎性小体表达水平的变化及临床意义

Changes and clinical significance of peripheral blood NLRP3 inflammasome expression in patients with severe pneumonia

目的 研究重症肺炎患者外周血NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎性小体表达水平的变化及临床意义。方法 选择2018年1月至2021年12月期间本院收治的72例重症肺炎患者和86例普通肺炎患者,分别作为重症肺炎组和普通肺炎组;另取同期进行健康体检的105名健康志愿者作为对照组。检测外周血中NLRP3、凋亡相关斑点样蛋白(ASC)、含半胱氨酸的天冬氨酸蛋白水解酶-1(Caspase-1)的mRNA表达水平,血清中白介素(IL)-1β、IL-18的含量,以及实验室指标白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、动脉血pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO_(2))。采用28 d的生存情况评估重症肺炎患者的预后。结果 三组间外周血中NLRP3、ASC、Caspase-1的mRNA表达水平及血清中IL-1β、IL-18的含量比较:重症肺炎组>普通肺炎组>对照组,差异有统计学意义(P<0.05)。重症肺炎组中NLRP3、ASC、Caspase-1与IL-1β、IL-18呈正相关(P<0.05);重症肺炎组中NLRP3高表达患者的WBC、hs-CRP、PCT、PaCO_(2)水平高于NLRP3低表达患者,PaO2水平及28d累积生存率均低于NLRP3低表达患者,差异有统计学意义(P<0.05)。pH值与NLRP3低表达患者比较差异无统计学意义(P>0.05)。结论 外周血NLRP3炎症小体高表达与重症肺炎病情加重、预后不良有关。

Objective To study the changes and clinical significance of Nod-like Receptor,Pyrin Domain Containing 3(NLRP3)inflammasome in peripheral blood of patients with severe pneumonia. Methods 72 patients with severe pneumonia and 86 patients with common pneumonia treated in our hospital from January 2018 to December 2021 were selected as the severe pneumonia group and the common pneumonia group respectively. Another 105 healthy volunteers who underwent physical examination in the same period were taken as the control group. The m RNA expression levels of NLRP3,Apoptosis-associated Speck-like Protein Containing a CARD(ASC),cysteinyl aspartate specific proteinase-1(Caspase-1)in peripheral blood and the contents of interleukin(IL)-1β,IL-18 in serum and laboratory indicators white blood cell count(WBC),high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),arterial blood pH value,arterial blood oxygen partial pressure(PaO_(2)),and arterial blood carbon dioxide partial pressure(PaCO_(2)) were detected. The prognosis of patients with severe pneumonia was evaluated by 28 day survival. Results The comparison of mRNA expressionlevels of NLRP3,ASC and caspase-1 in peripheral blood and the contents of IL-1β,IL-18 in serum among three groups:severe pneumonia group > common pneumonia group > control group(P<0.05). NLRP3,ASC,caspase-1 were positively correlated with IL-1β,IL-18 in the severe pneumonia group. In severe pneumonia group,the levels of WBC,hs-CRP,PCT and Pa CO_(2) in patients with high expression of NLRP3 were higher than those in patients with low expression of NLRP3,the level of Pa O_(2) and 28 day cumulative survival rate were lower than those in patients with low expression of NLRP3(P<0.05),the p H value had no significant difference with patients with low expression of NLRP3(P>0.05). Conclusion The high expression of NLRP3 inflammasome in peripheral blood is related to the aggravation and poor prognosis of severe pneumonia.