血清NLRP3、HMG-1、IL-10表达水平与脓毒症患者病情及预后的关系探究

The relationship between serum NLRP3,HMG-1,IL-10 expression levels and the condition and prognosis of patients with sepsis

目的研究脓毒症患者血清核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、高迁移率族蛋白1(HMG-1)、白细胞介素-10(IL-10)的表达水平状况及与病情和预后结局的相关性。方法选取该院于2022年1-12月收治的180例脓毒症患者作为脓毒症组,180例健康志愿者作为对照组。检测血清NLRP3、HMG-1、IL-10表达水平,分析对比三者在对照组、脓毒症组血清中的表达水平差异及与病情程度的关系。脓毒症患者入院后均行疾病针对性措施治疗,根据28 d预后进行预后分组,比较不同预后结局患者的NLRP3、HMG-1、IL-10表达水平及预测脓毒症患者预后结局的效能,以及NLRP3、HMG-1、IL-10不同表达水平患者28 d的生存率,明确脓毒症患者预后结局的影响因素。结果脓毒症组血清NLRP3、HMG-1、IL-10表达水平高于对照组,差异有统计学意义(P<0.05)。随着病情的加重,脓毒症患者血清NLRP3、HMG-1、IL-10表达水平逐渐升高,脓毒性休克患者表达水平高于重度脓毒症患者,重度脓毒症患者表达水平高于轻度脓毒症患者,差异有统计学意义(P<0.05)。死亡组血清NLRP3、HMG-1、IL-10表达水平高于生存组,差异有统计学意义(P<0.05)。多因素Logistic分析发现,脓毒性休克、快速脓毒症相关序贯器官衰竭评分、急性生理学与慢性健康状况评分系统Ⅱ评分、降钙素原、NLRP3、HMG-1、IL-10是影响脓毒症患者预后结局的独立危险因素(P<0.05)。受试者工作特征曲线分析NLRP3、HMG-1、IL-10预测脓毒症患者预后结局的效能发现,血清NLRP3、HMG-1、IL-10联合预测脓毒症患者预后结局曲线下面积为0.943,高于单一指标预测。血清NLRP3、HMG-1、IL-10在脓毒症中呈正相关(P<0.05)。NLRP3、HMG-1、IL-10高表达组患者生存率低于NLRP3、HMG-1、IL-10低表达组,差异有统计学意义(P<0.05)。结论NLRP3、HMG-1、IL-10高表达于脓毒症患者中,三者可能经促进炎症和细胞凋亡促进病情进展,导致预后不良,与患者病情和预后死亡相关,可作为临床评估脓毒症患者预后的敏感指标。

Objective To study the expression levels of nucleotide binding oligomeric domain like receptor protein 3(NLRP3),high mobility group protein 1(HMG-1),and interleukin-10(IL-10)in serum of patients with sepsis,and their correlation with disease condition and prognosis.Methods One hundred and eighty patients with sepsis admitted to 521 Hospital of Ordnance Industry from January to December 2022 were selected as the sepsis group,and 180 healthy volunteers were selected as the control group.Detect the expression levels of serum NLRP3,HMG-1,and IL-10,analyze and compare the expression differences of the three in the serum of the normal group and sepsis group,and their relationship with the severity of the disease.After admission,sepsis patients were treated with disease specific measures.Prognostic groups were divided based on the 28 day prognosis.The expression of NLRP3,HMG-1,and IL-10 levels in patients with different prognostic outcomes were compared,as well as the effectiveness of predicting the prognosis of sepsis patients.The 28 day survival rate of patients with different expression levels was also determined to determine the influencing factors of the prognosis of sepsis patients.Results The serum expression levels of NLRP3,HMG-1,and IL-10 in the sepsis group were higher than those in the normal group,and the difference was statistically significant(P<0.05).As the condition worsens,the serum expression levels of NLRP3,HMG-1,and IL-10 in sepsis patients gradually increase,the expression level in patients with septic shock is higher than that in patients with severe sepsis,and the expression level in patients with severe sepsis is higher than that in patients with mild sepsis,and the difference was statistically significant(P<0.05).The serum expression levels of NLRP3,HMG-1,and IL-10 in the death group were higher than those in the survival group,and the difference was statistically significant(P<0.05).Multivariate logistic analysis showed that septic shock,sequential organ failure assessment with repidsepsis score,acute physiology and chronic health evaluationⅡscore,pro Calcitonin,NLRP3,HMG-1,IL-10 were independent risk factors affecting the prognosis of sepsis patients(P<0.05).The receiver operating characteristic curve analysis showed that the efficacy of NLRP3,HMG-1,and IL-10 in predicting the prognosis of sepsis patients showed that the area under curve of the combination of serum NLRP3,HMG-1,and IL-10 in predicting the prognosis of sepsis patients was 0.943,higher than that predicted by a single indicator.Serum NLRP3,HMG-1,and IL-10 were positively correlated in sepsis(P<0.05).The survival rate of patients with high expression of NLRP3,HMG-1,and IL-10 was lower than that of patients with low expression of NLRP3,HMG-1,and IL-10,and the difference was statistically significant(P<0.05).Conclusion NLRP3,HMG-1 and IL-10 are highly expressed in sepsis,and they may promote the progression of the disease through promoting inflammation and apoptosis,leading to poor prognosis.They are related to the disease and prognostic death of patients,and can be used as sensitive indicators for clinical evaluation of the prognosis of patients with sepsis.