失血性休克患者外周血自噬标志基因表达水平与合并脏器损伤的相关性

Correlation between the expression level of autophagy marker gene in peripheral blood and combined organ injury of patients with hemorrhagic shock

目的研究失血性休克患者外周血自噬标志基因表达水平与合并脏器损伤的相关性。方法选择失血性休克患者128例作为失血性休克组,创伤出血且无休克患者54例作为创伤出血对照组、体检的健康志愿者150例作为健康对照组。所有受试者检测外周血Beclin-1、自噬相关蛋白5(autophagy protein 5,Atg5)蛋白表达水平。比较是否发生急性心力衰竭、急性肝损伤、急性肾损伤的失血性休克患者Beclin-1、Atg5蛋白表达水平。分析失血性休克患者Beclin-1、Atg5蛋白与损伤严重度评分、急性生理和慢性健康评分Ⅱ、序贯器官衰竭评分、N末端B型利钠肽原、总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、血肌酐、血尿素氮、左心室射血分数的相关性。结果失血性休克组患者外周血中自噬标志基因Beclin-1、Atg5的蛋白表达水平高于创伤出血对照组和健康对照组(P<0.05)。失血性休克组中入院后发生心力衰竭、肾损伤、肝损伤的患者入院时外周血中自噬标志基因Beclin-1、Atg5的蛋白表达水平低于未发生心力衰竭、肾损伤、肝损伤的患者(P<0.05)。失血性休克组患者入院时外周血中自噬标志基因Beclin-1、Atg5的蛋白表达水平与损伤严重度评分、急性生理和慢性健康评分Ⅱ、序贯器官衰竭评分、N末端B型利钠肽原、总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、血肌酐、血尿素氮呈负相关,与左心室射血分数呈正相关(P<0.05)。结论失血性休克患者外周血中自噬标志基因表达增加能够起到代偿性的保护作用,与病情加重、脏器损伤程度均呈负相关。

Objective To study the correlation between the expression level of autophagy marker gene in peripheral blood and combinedorgan injury of patients with hemorrhagic shock.Methods In total,128 hemorrhagic shock patients were selected as the hemorrhagic shock group,and 54 patients with traumatic hemorrhage but without shock were selected as the traumatic hemorrhage control group.In addition,150 healthy volunteers undergoing physical examination were selected as the healthy control group.The protein expression levels of Beclin-1 and autophagy protein 5(Atg5)in peripheral blood of all subjectswere detected.The expression levels of Beclin-1 and Atg5 proteins between hemorrhagic shock patients with and without acute heart failure,acute liver injury,and acute kidney injury were compared.The correlation of Beclin-1,Atg5 protein with injury severity score,acute physiology and chronic health evaluationⅡ(APACHE-Ⅱ)score,sequential organ failure assessment(SOFA)score,N-terminal pro B-type natriuretic peptide(NT-proBNP),total bilirubin(TB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum creatinine(SCr),blood urea nitrogen(BUN),left ventricular ejection fraction(LVEF)were analyzed.Results The protein expression levels of the autophagy marker genes Beclin-1 and Atg5 in the peripheral blood of hemorrhagic shock group were higher than those of the traumatic hemorrhage control group and healthy control group(P<0.05).In the hemorrhagic shock group,the protein expression levels of the autophagy marker genes Beclin-1 and Atg5 in the peripheral blood of patients with heart failure,kidney injury and liver injury after admission were lower than those of patients without heart failure,kidney injury and liver injury(P<0.05).The protein expression level of the autophagy marker genes Beclin-1 and Atg5 in the peripheral blood of patients with hemorrhagic shock at admission was negatively correlated with injury severity score,APACHE-Ⅱscore,SOFA score,NT-proBNP,TB,ALT,AST,SCr,and BUN,and positively correlated with LVEF.Conclusion The increased expression of autophagy marker genes in the peripheral blood of patients with hemorrhagic shock can play a compensatory protective role,which are negatively correlated with the aggravation of the disease and the degree of organ injury.