Prognosis value of heat-shock proteins in esophageal and esophagogastric cancer:A systematic review and meta-analysis

BACKGROUND Heat shock proteins(HSPs)are molecular chaperones that play an important role in cellular protection against stress events and have been reported to be overex-pressed in many cancers.The prognostic significance of HSPs and their regulatory factors,such as heat shock factor 1(HSF1)and CHIP,are poorly understood.AIM To investigate the relationship between HSP expression and prognosis in esophageal and esophagogastric cancer.METHODS A systematic review was conducted in accordance with PRISMA recommend-ations(PROSPERO:CRD42022370653),on Embase,PubMed,Cochrane,and LILACS.Cohort,case-control,and cross-sectional studies of patients with eso-phagus or esophagogastric cancer were included.HSP-positive patients were compared with HSP-negative,and the endpoints analyzed were lymph node metastasis,tumor depth,distant metastasis,and overall survival(OS).HSPs were stratified according to the HSP family,and the summary risk difference(RD)was calculated using a random-effect model.RESULTS The final selection comprised 27 studies,including esophageal squamous cell carcinoma(21),esophagogastric adenocarcinoma(5),and mixed neoplasms(1).The pooled sample size was 3465 patients.HSP40 and 60 were associated with a higher 3-year OS[HSP40:RD=0.22;95%confidence interval(CI):0.09-0.35;HSP60:RD=0.33;95%CI:0.17-0.50],while HSF1 was associated with a poor 3-year OS(RD=-0.22;95%CI:-0.32 to-0.12).The other HSP families were not associated with long-term survival.HSF1 was associated with a higher probability of lymph node metastasis(RD=-0.16;95%CI:-0.29 to-0.04).HSP40 was associated with a lower probability of lymph node dissemination(RD=0.18;95%CI:0.03-0.33).The expression of other HSP families was not significantly related to tumor depth and lymph node or distant metastasis.CONCLUSION The expression levels of certain families of HSP,such as HSP40 and 60 and HSF1,are associated with long-term survival and lymph node dissemination in patients with esophageal and esophagogastric cancer.

Cryopreservation-induced decrease in heat-shock protein 90 in human spermatozoa and its mechanism

<abstract>Aim: To study the protein changes of spermatozoa associated with sperm motility during sperm cryopreservation and its mechanism. Methods: In 18 healthy men, the seminal sperm motility and HSP90 levels were studied before and after cryopreservation using SDS-PAGE, Western blotting and computerized image analysis. Results: The sperm motility declined significantly after cryopreservation (P<0.01). The average grey level and the integrated grey level of sperm HSP90 before cooling were 34.1±3.2 and 243.0±21.6, respectively, while those after thawing were 23.2±2.5 and 105.7±28.5, respectively. Both parameters were decreased significantly (P<0.01). No HSP90 was found in the seminal plasma before and after cryopreservation. Conclusion: HSP90 in human spermatozoa was decreased substantially after cryopreservation. This may result from protein degradation, rather than leakage into the seminal plasma.

Effects of moxibustion on heat-shock protein 70 expression in the spinal cord and colonic mucosa in a rat model of ulcerative colitis

Pathological changes in the colon are closely associated with the spinal cord, and innervation of spinal cord can regulate cellular functions. Our previous studies verified that moxibustion protects and restores the colonic mucosa, but the mechanisms of action remain unknown. The present study observed the effects of moxibustion and salicylazosulfapyridine on expression of heat-shock protein 70 （HSP70） and its mRNA in the spinal cord and colonic mucosa of ulcerative colitis rats. Results demonstrated that moxibustion and salicylazosulfapyridine increased HSP70 mRNA expression in the spinal cord and colonic mucosa of ulcerative colitis rats. The decreased transcriptional activity of HSP70 in the spinal cord and colonic mucosa might participate in damage to the colonic mucosa in ulcerative colitis rats. Moxibustion exerted protective effects on colonic mucosa by up-regulating HSP70 transcriptional activity in the spinal cord and colonic mucosa.

C-reactive protein and radiographic findings of lower respiratory tract infection in infants

AIM To evaluate the association between C-reactive protein(CRP) and radiological evidence of lower respiratory tract infection(LRTI) in infants.METHODS All patients aged less than 4 years who presented with suspected lower respiratory tract infection,who received a peri-presentation chest radiograph and CRP blood measurement over an 18-mo period were included in the study.Age,gender,source of referral,CRP,white cell count,neutrophil count along with the patients' symptoms and radiologist's report were recorded.RESULTS Three hundred and eleven patients met the inclusioncriteria.Abnormal chest radiographs were more common in patients with elevated CRP levels(P < 0.01).Radiologic signs of LRTI were identified in 73.7% of chest radiographs when a patient had a CRP level between 50-99 mg/L.CRP levels were a better predictor of positive chest radiograph findings for those aged greater than I year compared to those 1 year or less.CONCLUSION CRP may be used in patients with suspected LRTI diagnosis to select those who are likely to have positive findings on chest radiograph,thus reducing unnecessary chest radiographs.

Application of GP5 Protein to Develop Monoclonal Antibody against Porcine Reproductive and Respiratory Syndrome Virus

In this study, a panel of monoclonal antibodies （mAbs） against Porcine reproductive and respiratory syndrome virus（PRRSV）, named as 8C9 and4B4, were produced by fusing SP2/0 myeloma cells and spleen cells of BALB/c mice immunized with the PRRSV （TCID50=5.5）, screened by the indirect ELISA and subjected to several limiting dilutions, mAbs were then identified by biological characterization. Among the two fusion cell strains, 8C9 belonged to the IgG1 subclass and 4B4 belonged to the IgG2a subclass. The titers in cell culture supematant and abdomen liquor reached to 1：104and 1：105, respectively. The specificity test indicated that the two cells had specific reactions for the PRRSV and GP5 protein respectively, and no reaction with Classical swine fever virus （CSFV） or Swine vesicular disease virus （SVDV）. The molecular weights of the heavy chain and light chain were about 45.0 kDa and 25.0 kDa, respectively. In neutralization activity tests, the results showed that the prepared mAb 4B4 can protect 50% of cells with no CPE in dilution up to 1：512, but mAB 8C9 has no neutralization activities to PRRSV.

Identification of the strain-specifically truncated nonstructural protein 10 of porcine reproductive and respiratory syndrome virus in infected cells

The nonstructural protein 10（nsp10） of porcine reproductive and respiratory syndrome virus（PRRSV） encodes for helicase which plays a vital role in viral replication. In the present study, a truncated form of nsp10, termed nsp10 a, was found in PRRSV-infected cells and the production of nsp10 a was strain-specific. Mass spectrometric analysis and deletion mutagenesis indicated that nsp10 a may be short of about 70 amino acids in the N terminus of nsp10. Further studies by rescuing recombinant viruses showed that the Glu-69 in nsp10 was the key amino acid for nsp10 a production. Finally, we demonstrated that nsp10 a exerted little influence on the growth kinetics of PRRSV in vitro.

Generation of Monoclonal Antibody to Porcine Reproductive and Respiratory Syndrome Virus GP4 Protein and Identification of Its Minic Epitopes

Porcine reproductive and respiratory syndrome virus(PRRSV)GP4 protein was prokaryotically expressed,and used as an antigen to immunize six-week-old BALB/c female mice.With conventional cell fusion method,an anti-PRRSV GP4 protein monoclonal antibody(Mab)5F12 was successfully prepared.It was identified as IgG2b subclass and had better stability and specificity,which not only responded with recombinant PRRSV GP4 protein,but also with PRRSV.Phage display technique had varieties of applications,in particular,the identification of key antigen epitopes for the development of therapeutic and diagnostic reagents and vaccines.In this study,Mab-5F12 was used as the target for biopanning a 12-mer phage random peptide library.After four rounds of biopanning,two phage-displayed peptides,named P-A and P-G(AKFEVCSPVVLG and GVNQENMLHFSF)were identified that recognized Mab-5F12 specifically.Sequence analysis showed that one or more of the peptides exhibited partial sequence similarity to the native GP4 protein sequence,which corresponded to 69-80 and 84-95 aa segments of the HP-PRRSV GP4 protein.Furthermore,real-time quantitative RT-PCR and indirect immunofluorescence assay indicated consistently the abilities of P-A and P-G to block viral infection in Marc-145 cells and they could function as antiviral agents for PRRSV.

Surfactant Protein D for Pathological Evaluation of Infant Acute Respiratory Distress Syndrome Caused by Respiratory Syncytial Virus Infection

Pediatric respiratory syncytial viral infection (RS) usually shows relatively good outcome;however, when it accompanies acute respiratory distress syndrome (ARDS), this becomes fatal. We experienced three pediatric patients with RS + ARDS, with all showing good outcome with steroid pulse therapy. We wish to emphasize;1) steroid pulse therapy may become an option for this condition, and 2) plasma KL-6 and surfactant protein D levels may become a biomarker reflecting the disease progression/condition. Patients were, aged 1 month, 1 year 5 months, and 1 year 11 months. In all three, the respiratory condition deteriorated rapidly, requiring invasive ventilator management. Although the effectiveness of steroid treatment for ARDS is controversial, very severe condition prompted us to employ steroid pulse therapy, after which, oxygenation rapidly improved without adverse events. Plasma KL-6 and surfactant protein D levels were measured during exacerbations of ARDS, steroid pulse therapy, and recovery. Surfactant protein D levels were closely associated with oxygenation, suggesting this substance level might be a biomarker of ARDS caused by the disruption of the alveolar epithelial lining and to understand oxygenation without time lag.

Hepatitis C virus inhibitor synergism suggests multistepinteractions between heat-shock protein 90 and hepatitis Cvirus replication

AIM: To address the effect of heat-shock protein 90(HSP90) inhibitors on the release of the hepatitis C virus(HCV), a cell culture-derived HCV(JFH1/HCVcc) from Huh-7 cells was examined.METHODS: We quantified both the intracellular and extracellular(culture medium) levels of the components(RNA and core) of JFH-1/HCVcc. The intracellular HCV RNA and core levels were determined after the JFH1/HCVcc-infected Huh-7 cells were treated with radicicol for 36 h. The extracellular HCV RNA and core protein levels were determined from the medium of the last 24 h of radicicol treatment. To determine the possible role of the HSP90 inhibitor in HCV release, we examined the effect of a combined application of low doses of the HSP90 inhibitor radicicol and the RNA replication inhibitors cyclosporin A(Cs A) or interferon. Finally, we statistically examined the combined effect of radicicoland Cs A using the combination index(CI) and graphical representation proposed by Chou and Talalay.RESULTS: We found that the HSP90 inhibitors had greater inhibitory effects on the HCV RNA and core protein levels measured in the medium than inside the cells. This inhibitory effect was observed in the presence of a low level of a known RNA replication inhibitor(Cs A or interferon-α). Treating the cells with a combination of radicicol and cyclosporin A for 24 h resulted in significant synergy(CI < 1) that affected the release of both the viral RNA and the core protein. CONCLUSION: In addition to having an inhibitory effect on RNA replication, HSP90 inhibitors may interfere with an HCV replication step that occurs after the synthesis of viral RNA, such as assembly and release.

Genetic Characterization of Fusion Protein of Human Respiratory Syncytial Virus: Beijing

Objective Fusion protein is a subunit of the human respiratory syncytial virus(HRSV)and a potential vaccine candidate.Thus,a study on the genetic characteristics of F protein was considered important for further investigations in this field.The aim of this study was to determine the prevalence and genetic diversity of the F gene of HRSV infections in hospitalized pediatric patients in Beijing with acute lower respiratory tract infections and to compare the circulating genotypes that are currently found worldwide.Methods HRSV particles were amplified by RT-PCR and the PCR products were purified for sequencing.Further analysis was carried out by Bioedit and MEGA 3.0 biological software programs.Results Seventy-six samples(23.1%)were positive for HRSV.The percentage of cases in patients younger than 1year was 84.21%.Among the six Beijing isolates,four belonged to subgroup A,whose respective F genes shared97.0%-97.4%nucleotide sequence identity and 92.1%-93.0%amino acid sequence identity.The other two isolates belonged to subgroup B.Here,97.3%and 98.2%sequence identity were found at nucleotide and amino acid levels,respectively.Conclusions Phylogenetic analysis of nucleotide sequences revealed that those four isolates within subgroup A were monophyletic and closely related to each other,but those two within subgroup B distributed in two distinct clusters.Subgroup A and B strains co-circulated,indicating that two different transmission chains occurred in Beijing from 2003-2004.

Research Progress of Combined Detection of WBC, CRP and SAA in Early Diagnosis of Respiratory Tract Infection in Children

Objective: To investigate the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. Methods: Collect the literature reports on the early diagnosis of respiratory tract infection in children by the combined detection of WBC, CRP and SAA in recent years, and follow up the relevant literature reports from the selection of “new three routine” laboratory items for rapid diagnosis in pediatric outpatient department and the application of the combined detection of WBC, CRP and SAA in the early diagnosis of respiratory tract infection in children. Results: Many literature studies found that the combined detection of WBC, CRP and SAA has important clinical significance in the early diagnosis of respiratory tract infection in children. Conclusion: Through reviewing the relevant literature, we can understand the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. To provide more accurate and reliable laboratory data for the early diagnosis and treatment of respiratory tract infection in children in the future.

急性呼吸窘迫综合征患儿血清Melatonin、MIP-1α与NLRP3炎症小体和预后的关系分析

目的探讨急性呼吸窘迫综合征(ARDS)患儿血清褪黑素(Melatonin)、巨噬细胞炎性蛋白-1α(MIP-1α)与核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎症小体和预后的关系。方法选取2021年1月至2023年1月该院收治的ARDS患儿140例纳入ARDS组,另选取同期100例体检健康儿童纳入对照组。根据入院28 d临床结局将ARDS患儿分为死亡组29例和存活组111例。采用酶联免疫吸附试验检测血清Melatonin、MIP-1α、白细胞介素(IL)-1β、IL-18水平,实时荧光定量PCR检测NLRP3 mRNA、半胱氨酸蛋白酶-1(Caspase-1)mRNA水平。采用Pearson相关分析ARDS患儿血清Melatonin、MIP-1α水平与NLRP3炎症小体相关指标(NLRP3 mRNA、Caspase-1 mRNA、IL-1β、IL-18)的相关性。采用多因素Cox回归分析影响ARDS患儿预后的因素。根据ARDS患儿血清Melatonin、MIP-1α水平均值分为高/低血清Melatonin、MIP-1α组,Kaplan-Meier法绘制高/低血清Melatonin、MIP-1α水平ARDS患儿生存曲线。采用受试者工作特征(ROC)曲线分析血清Melatonin、MIP-1α对ARDS患儿死亡的预测价值。结果与对照组比较,ARDS组血清Melatonin水平降低,血清MIP-1α、IL-1β、IL-18和外周血单核细胞NLRP3 mRNA、Caspase-1 mRNA水平升高(P<0.05)。Pearson相关分析显示,ARDS患儿血清Melatonin水平与NLRP3 mRNA、Caspase-1 mRNA、IL-1β、IL-18均呈负相关(P<0.05),MIP-1α水平与NLRP3 mRNA、Caspase-1 mRNA、IL-1β、IL-18均呈正相关(P<0.05)。多因素Cox回归分析显示,急性生理学和慢性健康状况评价Ⅱ评分、NLRP3 mRNA、Caspase-1 mRNA、IL-1β、IL-18、MIP-1α为影响ARDS患儿预后的独立危险因素,Melatonin为独立保护因素(P<0.05)。Kaplan-Meier生存曲线分析显示,高血清Melatonin组28 d生存率高于低血清Melatonin组(P<0.05),高血清MIP-1α组28 d生存率低于低血清MIP-1α组(P<0.05)。ROC曲线分析显示,血清Melatonin、MIP-1α联合预测ARDS患儿死亡的曲线下面积为0.881(95%CI 0.816~0.930),大于血清Melatonin、MIP-1α单独预测的0.785(95%CI 0.708~0.850)、0.778(95%CI 0.700~0.844)。结论ARDS患儿血清Melatonin水平降低、MIP-1α水平升高,与NLRP3炎症小体和预后密切相关,联合检测血清Melatonin、MIP-1α水平对ARDS患儿预后具有较高的预测价值。

血清LBP、CXCL-10对小儿急性上呼吸道细菌感染的鉴别诊断价值及其影响因素

目的探讨血清脂多糖结合蛋白(LBP)、血清CXC趋化因子配体-10(CXCL-10)对小儿急性上呼吸道细菌感染的鉴别诊断价值及其影响因素。方法将2021年7月至2022年6月该院收治的90例急性上呼吸道感染患儿纳入研究作为研究组。另选取同期于本院进行体检40例健康儿童作为健康组。根据痰液细菌培养结果将研究组患儿分为细菌感染组(51例)和非细菌感染组(39例)。采用酶联免疫吸附法检测血清LBP、CXCL-10水平。采用受试者工作特征(ROC)曲线评估血清LBP、CXCL-10对小儿急性上呼吸道细菌感染的鉴别诊断价值。采用多因素Logistic回归分析小儿急性上呼吸道细菌感染的影响因素。结果研究组血清LBP、CXCL-10水平高于健康组(P<0.05)。细菌感染组血清LBP、CXCL-10水平高于非细菌感染组(P<0.05)。血清LBP、CXCL-10单独及联合用于诊断小儿急性上呼吸道细菌感染的曲线下面积(AUC)分别为0.779(95%CI:0.724~0.822)、0.843(95%CI:0.796~0.898)、0.906(95%CI:0.852~0.959)。细菌感染组家庭成员吸烟、铁元素缺乏、钙元素缺乏者所占比例、年均抗菌药使用次数、血清LBP、CXCL-10水平均高于非细菌感染患者(P<0.05)。Logistic多因素回归分析显示,年均抗菌药使用次数≥2次(OR=2.305,95%CI:1.483~3.582)、LBP≥104.26 ng/mL(OR=2.573,95%CI:1.446~4.578)、CXCL-10≥112.98 pg/mL(OR=1.208,95%CI:0.110~1.314)是小儿急性上呼吸道细菌感染的影响因素(P<0.05)。结论血清LBP、CXCL-10水平升高与儿童急性上呼吸道细菌感染密切相关,可作为鉴别诊断急性上呼吸道细菌感染的指标且二者联合诊断的效能更高。

表现为急性呼吸衰竭的强直性肌营养不良1型一例

强直性肌营养不良1型(DM1)是一种常染色体显性遗传、多系统受累的肌营养不良,临床上主要表现为进行性肌肉无力、肌肉萎缩及肌强直。本文报道一例以急性呼吸衰竭为主要表现就诊的33岁DM1女性患者。神经电生理提示肌源性损害合并部分神经源性损害,股外侧肌活检提示肌细胞存在大量核内移。基因检测提示19号染色体DMPK基因CTG重复扩增(847±76)次,从而明确诊断为DM1。本例报道拓宽了临床医师对DM1不典型临床表现的认识,从而避免漏诊误诊。

红景天对急性呼吸窘迫综合征小鼠肺内皮细胞BMP9表达的影响

目的探讨红景天对肺血管通透性和骨形态发生蛋白9(BMP9)表达的影响。方法将90只C57BL/6小鼠按照随机数字表法分为假手术组、模型组和红景天低、中、高剂量组,每组18只。采用盲肠结扎穿孔法造模,假手术组开腹后关腹,红景天低、中、高剂量组分别用40、80、160 mg/kg红景天灌胃5 d,假手术组和模型组灌胃等量生理盐水。处死后,计算各组小鼠肺湿/干重比值,利用伊文思蓝染色法检测肺内皮细胞的渗透性,对小鼠肺组织进行免疫组化、Western blot法检测BMP9表达水平。使用脂多糖(LPS)诱导人脐静脉内皮细胞(HUVEC)形成内皮细胞炎性损伤模型,用CCK-8法检测细胞活性,筛选出合适的红景天给药浓度。将细胞分为对照组(无LPS诱导)、LPS组和25、50、100μg/mL红景天组,应用实时荧光定量PCR和Western blot检测BMP9表达情况。结果与模型组比较,红景天低、中、高剂量组小鼠肺湿/干重比值[(7.42±0.25)、(6.75±0.25)、(5.93±0.27)比(8.39±0.39),P<0.01]和肺内皮细胞的渗透性[(620.73±0.36)%、(469.26±0.39)%、(179.20±0.36)%比(706.86±0.37)%,P<0.05或P<0.01]均显著降低,且与红景天剂量呈正相关。Western blot和免疫组化检测发现,与假手术组比较,模型组BMP9表达明显减少;而红景天低、中、高剂量组BMP9表达较模型组增加,且与剂量呈正相关。实时荧光定量PCR结果显示,与对照组比较,LPS组HUVEC中BMP9 mRNA相对表达量显著下降[(0.18±0.08)比(1.00±0.11),P<0.01];与LPS组比较,红景天给药组BMP9 mRNA相对表达量随给药浓度增加而增加[(0.39±0.09)、(0.52±0.10)、(0.78±0.09)比(0.18±0.08),P<0.05或P<0.01],但均低于对照组。Western blot检测细胞BMP9蛋白表达发现,LPS诱导细胞炎性反应可以导致BMP9表达明显下降,红景天给药组的BMP9表达量均高于LPS组,且与剂量相关。结论红景天减轻了急性呼吸窘迫综合征小鼠肺损伤并在体外缓解了LPS诱导的内皮损伤,其肺血管保护作用可能与增加BMP9表达有关。

体积描记法联合血清单核细胞趋化蛋白-1水平预测急性下呼吸道感染患者合并哮喘的效能分析

目的探究体积描记法联合血清单核细胞趋化蛋白-1(MCP-1)对急性下呼吸道感染患者合并哮喘的预测价值。方法回顾性分析2019年6月—2022年12月青海省人民医院收治的188例急性下呼吸道感染患者的病历资料。根据患者住院期间是否并发哮喘分为合并组(48例)和非合并组(140例)。收集并整理所有受试者的人口学资料和实验室检测指标(体积描记法相关参数:肺总量、残气量、残气率,血清MCP-1水平)。比较两组患者临床资料的差异,分析肺总量、残气量与功能残气量(FRC)、MCP-1的相关性,分析影响急性下呼吸道感染患者并发哮喘的相关因素,以及FRC、MCP-1对急性下呼吸道感染患者并发哮喘的预测价值。结果合并组FRC、肺总量、残气量、残气率、MCP-1水平均高于非合并组(P<0.05)。FRC与肺总量、残气量水平均呈正相关(r=0.681和0.671,均P=0.001);MCP-1与肺总量、残气量水平均呈正相关(r=0.669和0.654,均P=0.001)。多因素逐步Logistic回归分析结果显示:FRC[O^R=2.450(95%CI:1.239,4.840)]、MCP-1[O^R=2.995(95%CI:1.516,5.918)]是急性下呼吸道感染患者并发哮喘的危险因素(P<0.05)。受试者工作特征曲线结果分析显示,FRC、MCP-1及联合预测急性下呼吸道感染患者并发哮喘的敏感性分别为72.92%(95%CI:0.579,0.842)、83.33%(95%CI:0.692,0.920)、79.17%(95%CI:0.645,0.890),特异性分别为81.43%(95%CI:0.737,0.873)、70.71%(95%CI:0.623,0.779)、81.43%(95%CI:0.737,0.873)。结论体积描记法和血清MCP-1水平可用于评估急性下呼吸道感染患者肺功能,且血清MCP-1与体积描记法检测的FRC对急性下呼吸道感染患者并发哮喘的预测效能良好。

危重患者血浆IGF-1和IGFBP-3水平对预测ARDS和预后判断的临床价值

目的探讨危重患者血浆胰岛素样生长因子(insulin-like growth factor,IGF)-1和胰岛素样生长因子结合蛋白(insulin-like growth factor binding protein,IGFBP)-3水平对预测急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)和预后判断的临床价值。方法回顾性分析131例在温州医科大学附属第一医院重症监护室住院的危重患者,检测入组患者血浆IGF-1、IGFBP-3水平和血生化、降钙素原(procalcitonin,PCT)、乳酸(lactic acid,LAC)、血白蛋白等。计算入组患者60d病死率。比较ARDS患者和对照组患者及60d死亡患者和生存患者的差异。结果ARDS组患者血浆IGF-1、IGFBP-3明显低于对照组,而PCT高于对照组。死亡组患者血浆IGF-1、IGFBP-3水平明显低于存活组。多因素Logistic回归分析和受试者操作特征曲线结果显示IGF-1曲线下面积(area under the curve,AUC)为0.770、序贯器官衰竭评分(sequential organ failure assessment,SOFA)评分(AUC=0.692)和PCT(AUC=0.710)是危重患者发生ARDS的独立危险因素,IGF-1(AUC=0.807)、IGFBP-3(AUC=0.759)和SOFA评分(AUC=0.859)是危重患者死亡发生的独立危险因素。结论危重患者血浆IGF-1、IGFBP-3水平明显降低,血浆IGF-1和IGFBP-3水平降低是危重患者可能发生ARDS和死亡的重要因素。

血清MyD88和TRAF-6联合检测在儿童重度急性呼吸道感染诊断和预后评估中的价值

目的探讨血清髓系分化初级反应蛋白88(MyD88)、肿瘤坏死因子受体相关因子6(TRAF-6)在儿童重度急性呼吸道感染辅助诊断和预后评估中的价值。方法选取2020年1月—2022年6月南阳市中心医院儿童急性呼吸道感染患儿80例(急性呼吸道感染组)。根据病原学检测结果分为非细菌感染组(42例)和细菌感染组(38例)。根据患儿病情严重程度分为轻度组(28例)、中度组(20例)、重度组(32例)。根据患儿预后情况分为预后良好组(58例)和预后不良组(22例)。以同期80名体检健康儿童为正常对照组。采用多因素Logistic回归分析评估急性呼吸道感染患儿预后的影响因素。采用受试者工作特征(ROC)曲线评价各项指标诊断儿童重度急性呼吸道感染和评估预后的效能。结果急性呼吸道感染组血清MyD88、TRAF-6水平显著高于正常对照组(P<0.001)。细菌感染组血清MyD88、TRAF-6水平显著高于非细菌感染组(P<0.001)。轻度组、中度组、重度组血清MyD88、TRAF-6水平依次升高(P<0.001)。ROC曲线分析结果显示,血清MyD88、TRAF-6单项检测和联合检测诊断重度急性呼吸道感染的曲线下面积(AUC)分别为0.762、0.734、0.876。预后不良组细菌感染、下呼吸道感染、重度病情所占比例和白细胞(WBC)计数、反应蛋白(CRP)、MyD88、TRAF-6水平均显著高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,重度病情、CRP升高、MyD88升高、TRAF-6升高均是儿童急性呼吸道感染预后不良的危险因素[比值比(OR)值分别为1.693、1.864、3.218、2.869,95%可信区间(CI)分别为1.142~2.510、1.228~2.830、1.561~6.633、1.511~5.446,P<0.05]。ROC曲线分析结果显示,血清MyD88、TRAF-6、CRP单项检测和联合检测判断急性呼吸道感染患儿预后的AUC分别为0.848、0.900、0.817、0.951。结论急性呼吸道感染患儿血清MyD88、TRAF-6水平显著升高,联合检测对儿童重度急性呼吸道感染的辅助诊断和预后评估均有较高的临床价值。

呼吸窘迫综合征早产儿血清NGAL的动态变化及其对支气管肺发育不良的早期预测价值

目的探讨呼吸窘迫综合征早产儿血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的动态变化情况,并分析其对患儿发生支气管肺发育不良(BPD)的早期预测价值。方法前瞻性选取平顶山市第一人民医院儿科2019年8月至2023年1月收治的81例呼吸窘迫综合征早产儿作为研究对象。分别检测出生24 h内及出生后3、7、14 d的血清NGAL水平,并收集基线资料。根据患儿出生后28 d是否发生BPD分为发生组与未发生组,比较两组患儿不同时点的血清NGAL水平及基线资料,使用点二列相关性检验血清NGAL动态变化与呼吸窘迫综合征患儿发生BPD之间的关系,再绘制受试者工作特征(ROC)曲线,分析血清NGAL动态变化对呼吸窘迫综合征早产儿发生BPD的早期预测价值。结果共纳入81例呼吸窘迫综合征早产儿,因出现不良结局脱落1例,因家长申请退出研究脱落1例,最终79例患儿完成研究。其中有30例患儿出现BPD,发生率为37.97%(30/79)。发生组肿瘤坏死因子-α(TNF-α)、血浆Ⅱ型肺泡细胞表面抗原(KL-6)高于未发生组(P<0.05)。出生24 h内两组血清NGAL差异无统计学意义(P>0.05);出生后3、7、14 d发生组血清NGAL水平高于未发生组(P<0.05)。点二列相关性检验显示,出生3、7、14 d的血清NGAL水平、TNF-α、血浆KL-6与呼吸窘迫综合征患儿出现BPD呈正相关关系(r>0,P<0.05)。ROC曲线显示出生后3 d血清NGAL对呼吸窘迫综合征患儿出现BPD的预测价值较低,曲线下面积(AUC)为0.643,而出生后7 d血清NGAL对患儿出现BPD具有中等预测价值,AUC为0.866;出生后14 d的血清NGAL对患儿出现BPD具有较高预测价值,AUC为0.935。结论血清NGAL动态变化对呼吸窘迫综合征患儿出现BPD具有一定的预测价值,且出生后14 d预测价值最高。

儿童肺炎支原体肺炎肺泡灌洗液CARDS TX、HMGB1、TLR2表达及临床意义

目的研究肺炎支原体肺炎(MPP)患儿肺泡灌洗液中社区获得性呼吸窘迫综合征毒素(CARDS TX)、高迁移率族蛋白1(HMGB1)、Toll样受体2(TLR2)表达,探讨其在MPP发病中的临床意义。方法回顾性分析55例MPP病例组及20例对照组临床资料,同时检测两组支气管肺泡灌洗液(BALF)中CARDS TX、HMGB1、TLR2、TLR4、晚期糖基化终末产物受体(RAGE)及髓样分化因子88(MyD88)表达,体外检测不同浓度CARDS TX刺激下HMGB1、TLR2的表达并进行比较。结果与对照组相比,MPP组LYM绝对值计数、PA、CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)、CD3-CD19^(+)、NK cell、CD19^(+)CD23^(+)明显下降,CRP、LDH、D-二聚体、IgA、IgG、IgM、CARDS TX、HMGB1、TLR2、MyD88均升高,差异有统计学意义(P<0.05或0.001)。CARDS TX刺激后HMGB1、TLR2的表达升高,且呈正相关,差异有统计学意义(P<0.001)。结论CARDS TX可能通过HMGB1-TLR2-MyD88途径参与肺炎支原体(MP)的致病。