基于外周血A20 mRNA和NF-κB mRNA及Foxp3 mRNA水平的创伤合并感染患者预后评估

Assessment of prognosis of trauma patients complicated with infection based on peripheral blood A20 mRNA, NF-κB mRNA and Foxp3 mRNA

目的 探究外周血锌指蛋白(A20)mRNA、核因子κB(NF-κB)mRNA及叉状头/翅膀状螺旋转录因子(Foxp3)mRNA水平与创伤患者合并感染预后的评估价值。方法 选取山东省立第三医院2018年6月-2020年6月创伤患者182例,根据是否合并感染分为感染组74例与未感染组108例,根据创伤严重度评分(ISS)将患者分为轻伤组、重伤组和危重伤组,根据感染严重程度将患者分为轻度组、中度组和重度组,根据患者28 d预后结果将患者分为存活组和病死组,比较各组患者外周血A20 mRNA、NF-κB mRNA及Foxp3 mRNA水平。采用受试者工作特征(ROC)曲线评价A20 mRNA、NF-κB mRNA及Foxp3 mRNA水平对患者预后的评估作用。结果 感染组患者外周血A20 mRNA低于未感染组,NF-κB mRNA及Foxp3 mRNA水平高于未感染组(P<0.05);对于创伤合并感染患者,不同创伤严重程度、感染严重程度患者A20 mRNA、NF-κB mRNA及Foxp3 mRNA,差异有统计学意义(P<0.05);存活组患者A20 mRNA高于病死组,NF-κB mRNA及Foxp3 mRNA低于病死组(P<0.05)。A20 mRNA、NF-κB mRNA及Foxp3 mRNA评估创伤合并感染患者预后,联合检测曲线下面积(AUC)为0.898,大于单项指标(A20:Z=2.148,P=0.032;NF-κB:Z=3.251,P<0.001;Foxp3:Z=2.188,P=0.029)。结论 外周血A20、NF-κB及Foxp3 mRNA与创伤合并感染患者病情严重程度及预后相关,可作为评估患者预后的良好指标。

OBJECTIVE To explore the correlation between peripheral blood zinc finger protein(A20), nuclear factor kB(NF-κB), forkhead/winged helix transcription factor(Foxp3) mRNA and infection severity, prognosis in trauma patients. METHODS A total of 182 patients with trauma in Shandong Third Provincial Hospital were enrolled between Jun. 2018 and Jun. 2020. According to presence or absence of infection, they were divided into infection group(74 cases) and non-infection group(108 cases). According to injury severity score(ISS), they were divided into mild injury group, severe injury group and critical injury group. According to the severity of infection, infection patients were divided into mild, moderate and severe groups. According to 28 d prognosis, patients were divided into survival group and death group. The levels of peripheral blood A20, NF-κB and Foxp3 mRNA in different groups were compared. The prognostic value of A20, NF-κB and Foxp3 mRNA was evaluated by receiver operating characteristic(ROC) curves. RESULTS The level of peripheral blood A20 mRNA in infection group was lower than that in non-infection group, while mRNA levels of NF-κB and Foxp3 were higher than those in non-infection group(P<0.05). For patients with trauma and infection, there were significant differences in levels of A20, NF-κB and Foxp3 mRNA among patients with different severity of trauma and infection(P<0.05). The level of A20 mRNA in survival group was higher than that in death group, while mRNA levels of NF-κB and Foxp3 were lower than those in death group(P<0.05). The area under the curve(AUC) value of A20 combined with NF-κB and Foxp3 mRNA for assessing the prognosis of patients with trauma and infection was 0.898, greater than that of single index(A20: Z=2.148, P=0.032. NF-κB: Z=3.251, P<0.001. Foxp3: Z=2.188, P=0.029). CONCLUSION The levels of peripheral blood A20, NF-κB and Foxp3 mRNA are related to disease severity and prognosis in patients with trauma and infection, which can be applied as good indexes to assess prognosis.