AECOPD并发肺部细菌感染患者外周血铁死亡相关基因表达与病情的关系

The relationship between expression of iron death-related genes in peripheral blood and condition of patients with AECOPD and lung bacterial infection

目的 分析慢性阻塞性肺疾病急性加重(AECOPD)并发肺部细菌感染患者外周血铁死亡相关基因表达变化与病情的关系。方法 选择济南市人民医院呼吸科2019年2月-2021年2月因AECOPD入院治疗患者75例为研究对象,根据患者痰培养结果,将患者分为肺部细菌感染组(n=50)和非感染组(n=25)。患者在入院当天留取清晨痰标本对病原菌种进行鉴定。研究对象均在入组当天清晨抽取外周静脉血采用实时荧光定量聚合酶链式反应(RT-PCR)法检测谷胱甘肽过氧化物酶4(GPX4)、转铁蛋白受体-1(TFR1)、热休克蛋白B1(HSPB1)基因mRNA水平;采用酶联免疫吸附法(ELISA)检测血清中铁调素、转铁蛋白和铜蓝蛋白水平。结果 50例合并肺部感染患者经病原菌培养共分离出病原菌50株,其中革兰阴性菌36株,占72.00%,革兰阳性菌14株,占28.00%;三组GPX4、TFR1和HSPB1 mRNA水平以及血清中铁调素、转铁蛋白和铜蓝蛋白水平整体差异具有统计学意义(P<0.05);感染组GPX4、TFR1和HSPB1 mRNA水平以及血清中铁调素、转铁蛋白和铜蓝蛋白水平高于非感染组以及对照组(P<0.05);重度感染组GPX4、TFR1和HSPB1 mRNA水平以及血清中铁调素、转铁蛋白和铜蓝蛋白水平高于轻度感染组以及中度感染组(P<0.05)。结论 铁凋亡通路基因GPX4、TFR1和HSPB1以及铁代谢相关蛋白铁调素、转铁蛋白和铜蓝蛋白参与AECOPD患者肺部感染进程,其机制还需深入研究。

OBJECTIVE To analyze the relationship between the expression changes of peripheral blood iron death-related genes and the condition in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and pulmonary bacterial infection. METHODS A total of 75 patients from the Department of Respiratory Medicine of Jinan People′s Hospital from Feb 2019 to Feb 2021 were recruited as the research subjects. After bacteria detection of sputum from the patients, they were divided into the pulmonary bacterial infection group(n=50) and the non-infection group(n=25). Sputum samples in the early morning collected from patients on the day of admission were used to detect pathogenic bacteria. mRNA expression levels of glutathione peroxidase 4(GPX4), transferrin receptor-1(TFR1), heat shock protein B1(HSPB1) gene in the venous blood were detected by real-time fluorescence quantitative polymerase chain reaction(RT-PCR) assay. Serum hepcidin, transferrin and ceruloplasmin levels were detected by enzyme-linked immunosorbent assay(ELISA). RESULTS A total of 50 strains of pathogenic bacteria were cultured from specimens from 50 patients combined with lung infection, including 36 Gram-negative bacteria, accounting for 72.00%, and 14 Gram-positive bacteria, accounting for 28.00%. The overall difference of GPX4, TFR1 and HSPB1 mRNA levels among the three groups was significant(P<0.05). The differences of the mRNA levels of GPX4, TFR1 and HSPB1 in the infection group were significantly higher than those in the non-infection group(P<0.05). The levels of GPX4, TFR1 and HSPB1 mRNA and serum hepcidin, transferrin and ceruloplasmin levels in the severe infection group were significantly higher than those in the mild infection group and the moderate infection group(P<0.05). CONCLUSION The iron apoptosis pathway genes such as GPX4, TFR1 and HSPB1 and the iron metabolism-related proteins hepcidin, transferrin and ceruloplasmin are involved in the process of lung infection in patients with AECOPD, and the mechanisms need to be further studied.