肛周脓肿组织SBP1、IL-17表达与患者临床病理特征及预后的关系

The relationship between the expression of SBP1 and IL-17 in perianal abscess tissue and the clinical pathological characteristics and prognosis of patients

目的分析肛周脓肿组织硒结合蛋白1(SBP1)、白介素-17(IL-17)表达与患者临床病理特征及预后的关系。方法选取2020年1月—2021月12月上海交通大学医学院附属新华医院日间病房手术治疗肛周脓肿患者120例作为肛周脓肿组,并根据6个月预后情况分为预后良好亚组75例和预后不良亚组45例。另选取同期收治的无感染混合痔患者120例作为对照组,留取2组病变组织标本,检测并比较2组患者局部病变组织中SBP1、IL-17 mRNA相对表达量及蛋白阳性表达率,分析肛周脓肿患者局部组织中SBP1、IL-17蛋白阳性表达率、mRNA相对表达量与临床病理特征的关系;Logistic多因素回归分析影响肛周脓肿患者预后的危险因素;采用受试者工作特征曲线(ROC)分析SBP1、IL-17 mRNA相对表达量对肛周脓肿患者预后的预测价值。结果肛周脓肿组SBP1 mRNA相对表达量及蛋白阳性率低于对照组[t(χ^(2))/P=30.059/<0.001,33.189/<0.001],IL-17 mRNA相对表达量及蛋白阳性率高于对照组[t(χ^(2))/P=29.003/<0.001,126.159/<0.001];预后不良亚组患者局部组织中SBP1 mRNA相对表达量、蛋白阳性率均低于预后良好亚组[t(χ^(2))/P=10.051/<0.001,6.012/0.014],而IL-17 mRNA相对表达量、蛋白阳性率均高于预后良好亚组[t(χ^(2))/P=5.597/0.018,4.474/<0.001]。肛周局部组织中SBP1、IL-17表达在不同患者性别、年龄、脓肿位置、感染类型、病程比较差异无统计学意义(P>0.05);与脓肿<5 cm比较,脓肿≥5 cm患者SBP1 mRNA相对表达量、蛋白阳性率降低[t(χ^(2))/P=3.630/<0.001,4.472/0.034],IL-17 mRNA相对表达量、蛋白阳性率升高[t(χ^(2))/P=4.387/<0.001,7.721/0.005];与术后愈合时间<4周比较,术后愈合时间≥4周患者SBP1 mRNA相对表达量、蛋白阳性率降低[t(χ^(2))/P=3.070/0.003,4.577/0.032],IL-17 mRNA相对表达量、蛋白阳性率显著升高[t(χ^(2))/P=5.768/<0.001,5.006/0.025]。Logistic多因素回归分析显示,术后愈合时间≥4周、SBP1表达降低、IL-17表达升高是影响肛周脓肿患者预后的独立危险因素[OR(95%CI)=1.373(0.623~3.056)、4.237(1.924~10.683)、4.521(4.125~11.878)];SBP1、IL-17 mRNA及二者联合预测肛周脓肿的AUC分别为0.888、0.890、0.933,二者联合优于各自单独预测效能(Z/P=3.583/<0.001,4.252/<0.001)。结论肛周脓肿局部组织中SBP1、IL-17表达异常,与肛周脓肿大小、愈合时间及患者预后相关,检测SBP1、IL-17 mRNA相对表达量对预测患者预后具有一定的临床价值,且联合预测的效能更优。

Objective To analyze the relationship between the expression of selenium binding protein 1(SBP1)and interleukin-17(IL-17)in perianal abscess tissue and the clinical pathological characteristics and prognosis of patients.Methods One hundred and twenty patients with perianal abscess who underwent surgical treatment in the daytime ward of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to December 2021 were selected as the perianal abscess group.Based on the prognosis after 6 months,they were divided into a subgroup of 75 patients with good prognosis and a subgroup of 45 patients with poor prognosis.Another 120 non-infected mixed hemorrhoid patients admitted at the same time were selected as the control group.Two groups of pathological tissue samples were collected,and the relative expression levels of SBP1 and IL-17 mRNA and protein positive expression rates in the local pathological tissues of the two groups of patients were detected and compared.The relationship between the positive expression rates of SBP1 and IL-17 protein,relative expression levels of mRNA and clinical pathological characteristics in the local tissues of patients with perianal abscess was analyzed;Logistic multiple factor regression analysis is used to identify the risk factors that affect the prognosis of patients with perianal abscess;The predictive value of relative expression levels of SBP1 and IL-17 mRNA on the prognosis of patients with perianal abscess was analyzed using the receiver operating characteristic curve(ROC).Results The relative expression level and protein positive rate of SBP1 mRNA in the perianal abscess group were lower than those in the control group[t(χ^(2))/P=30.059/<0.001,33.189/<0.001],the relative expression level of IL-17 mRNA and protein positivity rate were higher than those in the control group[t(χ^(2))/P=29.003/<0.001,126.159/<0.001];The relative expression level and protein positivity rate of SBP1 mRNA in local tissues of patients with poor prognosis subgroup were lower than those of patients with good prognosis subgroup(χ^(2)/P=10.051/<0.001,6.012/0.014),while the relative expression level of IL-17 mRNA and protein positivity rate were higher than those in the subgroup with good prognosis[t(χ^(2))/P=5.597/0.018,4.474/<0.001].There was no statistically significant difference in the expression of SBP1 and IL-17 in the local tissues around the anus among different patients'gender,age,abscess location,infection type,and disease course(P>0.05);Compared with abscesses<5 cm,patients with abscesses≥5 cm showed a decrease in the relative expression of SBP1 mRNA and protein positivity rate[t(χ^(2))/P=3.630/<0.001,4.472/0.034],the relative expression level of IL-17 mRNA and protein positivity rate increased[t(χ^(2))/P=4.387/<0.001,7.721/0.005];Compared with postoperative healing time<4 weeks,patients with postoperative healing time≥4 weeks showed a decrease in the relative expression of SBP1 mRNA and protein positivity rate[t(χ^(2))/P=3.070/0.003,4.577/0.032],the relative expression level of IL-17 mRNA and protein positivity rate increased[t(χ^(2))/P=5.768/<0.001,5.006/0.025].Logistic multivariate regression analysis showed that a decrease in SBP1 expression and an increase in IL-17 expression were independent risk factors affecting the prognosis of patients with perianal abscess after a healing time of≥4 weeks after surgery[OR(95%CI)=1.373(0.623-3.056),4.237(1.924-10.683),4.521(4.125-11.878)];The AUC of SBP1,IL-17 mRNA,and their combination in predicting perianal abscess were 0.888,0.890,and 0.933,respectively.The combination of the two was superior to their respective predictive efficacy alone(Z/P=3.583/<0.001,4.252/<0.001).Conclusion The abnormal expression of SBP1 and IL-17 in local tissues of perianal abscess is related to the size,healing time,and patient prognosis of the abscess.Detecting the relative expression levels of SBP1 and IL-17 mRNA has certain clinical value in predicting patient prognosis,and the combined prediction is more effective.