感染性休克患者预后影响因素及循环组蛋白和NLRP3炎症小体对预后的价值

Influencing factors for prognosis of septic shock patients and values of circulating histones and NLRP3 inflammasome in prediction of prognosis

目的分析引起感染性休克患者预后不良的危险因素并探讨循环组蛋白及NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎症小体与患者预后的关联性。方法选取2020年10月-2023年2月金华市中心医院收治的感染性休克患者80例,分析感染病原菌分布特点,并根据预后分为存活组43例,死亡组37例,采用多元Logistic回归分析预后影响因素,采用受试者工.作特征(ROC)曲线分析外周血循环组蛋白、NLRP3炎症小体对预后的预测价值。结果80例感染性休克患者共分离出93株病原菌,其中革兰阴性菌61株占65.59%,革兰阳性菌24株占25.81%,真菌8株占8.60%;多因素分析结果显示:年龄≥60岁及高水平的多器官功能障碍综合征(MODS)评分、循环组蛋白、NLRP3均是感染性休克患者死亡的影响因素(P<0.05);ROC曲线显示:循环组蛋白临界值为0.30 mg/L时预测不良预后的敏感度、特异性分别为85.82%、83.93%,曲线下面积(AUC)为0.881;NLRP3炎症小体mRNA相对表达量临界值为1.98时预测不良预后的敏感度、特异性分别为88.37%、67.57%,AUC为0.823。结论老年人及高水平MODS评分、循环组蛋白、NLRP3会增加感染性休克患者死亡风险,循环组蛋白及NLRP3炎症小体均可作为早期预测感染性休克患者预后的指标。

OBJECTIVE To investigate the risk factors for adverse prognosis of the patients with septic shock and explore the association of circulating histones and NOD-like receptor thermal protein domain associated protein 3(NLRP3)with the prognosis.METHODS A total of 80 patients with septic shock who were treated in Jinhua Cen-tral Hospital from Oct 2020 to Feb 2023 were enrolled in the study and were divided into the survival group with 43 cases and the death group with 37 cases according to the prognosis.The distribution of pathogens was ob-served,multivariate logistic regression analysis was performed for influencing factors for the prognosis.The val-ues of the peripheral blood circulating histones and NLRP3 inflammasome in prediction of the prognosis were ana-lyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 93 strains of pathogens were isolated from the 80 patients with septic shock,61(65.59%)of which were gram-negative bacteria,24(25.81%)were gram-positive bacteria,and 8(8.60%)were fungi.The result of multivariate analysis showed that no less than 60 years of age,high grade of multiple organ dysfunction syndrome(MODS)score,circulating histones and NLRP3 were the influencing factors for death of the patients with septic shock(P<0.05).ROC curve analysis indicated that the sensitivity and specificity of the circulating histones were respectively 85.82%and 83.93%in prediction of adverse prognosis when the critical value was 0.30 mg/L,with the area under curve(AUC)0.881.The sensitivity and specificity of the NLRP3 inflammasome were respectively 88.37%and 67.57%in prediction of adverse prognosis when the critical value of relative expression of mRNA was 1.98,with the AUC 0.823.CONCLUSION The old age,high score of MODS,circulating histones and NLRP3 may increase the risk of death of the patients with septic shock.The circulating histones and NLRP3 inflammasome can be used as the indexes for early prediction of prognosis of the septic shock patients.