转位分子蛋白和创伤后血清游离线粒体预测创伤性休克患者病情及预后的价值

Values of translocator protein and post-traumatic serum cell-free mitochondria in predicting disease condition and prognosis of patients with traumatic shock

目的探讨转位分子蛋白(TSPO)和创伤后血清游离线粒体DNA(cf-mtDNA)预测创伤性休克患者病情及预后的价值。方法选取创伤性休克患者(创伤性休克组)和无创伤性休克患者(无创伤性休克组)各80例。收集患者完整的人口统计学资料和临床实验室数据。收集入院后即刻(T_(1))以及入院后第1(T_(2))、3(T_(3))、7(T_(4))天创伤性休克患者的血液样本,采用酶联免疫吸附法(ELISA)检测TSPO水平,采用定量实时聚合酶链式反应(qPCR)检测cf-mtDNA水平。比较创伤性休克与无创伤性休克患者的TSPO、cf-mtDNA水平;将创伤性休克患者按预后结局的不同分为预后不良组和预后良好组,比较2组的TSPO、cf-mtDNA水平。采用受试者工作特征(ROC)曲线分析TSPO、cf-mtDNA对创伤性休克患者预后的预测价值。结果与无创伤性休克组比较,创伤性休克组T_(1)~T_(4)的血清TSPO较高,T_(2)~T_(3)的血清cf-mtDNA较高,差异均有统计学意义(P<0.05)。与预后良好组比较,预后不良组T_(1)~T_(4)的血清TSPO、cf-mtDNA较高,差异有统计学意义(P<0.05)。以创伤性休克患者预后作为状态变量进行ROC曲线分析,结果显示,预后不良组T_(1)~T_(4)的TSPO预测预后的曲线下面积(AUC)依次为0.825、0.829、0.695和0.869,预后不良组T_(1)~T_(4)的cf-mtDNA预测预后的AUC为0.766、0.766、0.837和0.783,差异均有统计学意义(P<0.001)。结论创伤性休克患者TSPO及cf-mtDNA水平升高,其中预后不良者TSPO及cf-mtDNA水平升高更为显著,而第7天的TSPO水平以及第3天的cf-mtDNA水平评估预后价值最高。

Objective To explore the values of translocator protein(TSPO)and serum cell-free mitochondrial DNA(cf-mtDNA)in predicting the disease condition and prognosis of patients with traumatic shock.Methods Eighty patients(traumatic shock group)with traumatic shock and eighty patients(without traumatic shock group)without traumatic shock were selected.Complete demographic and clinical laboratory data of patients were collected.Blood samples of patients with traumatic shock were collected at the time points of immediately after admission(T_(1))and the first day(T_(2)),the third day(T_(3))and seventh day(T_(4))after admission,the level of TSPO was measured by enzyme-linked immunosorbent assay(ELISA),and level of cf-mtDNA was measured by quantitative real-time polymerase chain reaction(qPCR).The levels of TSPO and cf-mtDNA were compared between patients with and without traumatic shock;the patients with traumatic shock were divided into the poor prognosis group and good prognosis group according to differed prognostic outcome,and the levels of TSPO and cf-mtDNA were compared between the two groups.The predictive values of TSPO and cf-mtDNA for the prognosis of patients with traumatic shock were analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the no traumatic shock group,the traumatic shock group had higher levels of serum TSPO at T_(1) to T_(4) and higher levels of cf-mtDNA at T_(2) to T_(3),and the differences were statistically significant(P<0.05).Compared with the good prognosis group,the poor prognosis group had higher levels of serum TSPO and cf-mtDNA at T_(1) to T_(4),and the differences were statistically significant(P<0.05).Taking the prognosis of traumatic shock patients as the state variable to perform ROC curve analysis,the results showed that the area under the curve(AUC)of TSPO from T_(1) to T_(4) for predicting prognosis in the poor prognosis group was 0.825,0.829,0.695 and 0.869 respectively,while those of cf-mtDNA level from T_(1) to T_(4) for predicting prognosis in the poor prognosis group was 0.766,0.766,0.837 and 0.783 respectively,and the differences were statistically significant(P<0.001).Conclusion Traumatic shock patients have elevated levels of TSPO and cf-mtDNA,with significantly higher levels observed in those with poor prognosis,and the TSPO level on the seventh day and cf-mtDNA level on the third day have the highest predictive value for prognosis.