NLRP3炎症小体、高迁移率族蛋白B1与内皮细胞特异性分子-1诊断脓毒症合并急性呼吸窘迫综合征的临床价值  

The value of NLRP3 inflammasome,HMGB1 and ESM-1 levels in the diagnosis of sepsis complicated with acute respiratory distress syndrome

作　　者：叶云虹 王念[1] 聂诗雨 王洪锦 伍星星 邱然 Ye Yunhong;Wang Nian;Nie Shiyu;Wang Hongjin;Wu Xingxing;Qiu Ran(Department of Critical Care Medicine,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院重症医学科,重庆402160

出　　处：《中国医刊》2022年第5期512-516,共5页Chinese Journal of Medicine

基　　金：重庆市科卫联合医学科研计划项目(渝卫发[2020]65号)。

摘　　要：目的 探究核苷酸结合寡聚化结构域样受体蛋白3(nucleotide-binding oligomerization domain-like receptor protein 3,NLRP3)炎症小体、高迁移率族蛋白B1(high-mobilitygroupbox-B1,HMGB1)以及内皮细胞特异性分子-1(endothelialcell specificmolecule-1,ESM-1)对脓毒症合并急性呼吸窘迫综合征(acuterespiratorydistresssyndrome,ARDS)的诊断价值。方法 选择重庆医科大学附属永川医院2021年1月至2021年6月收治的87例脓毒症患者,根据ARDS诊断标准,将36例合并ARDS的脓毒症患者作为观察组,51例单纯脓毒症患者作为脓毒症对照组,另选择同期在重庆医科大学附属永川医院体检的健康体检者43例作为健康对照组,收集各组基本临床资料,并测定各组NLRP3 mRNA、HMGB1、ESM-1水平,采用logistic回归分析脓毒症合并ARDS的影响因素,并通过受试者工作特征(receiver operating characteristic,ROC)曲线观察HMGB1、ESM-1、NLRP3mRNA+HMGB1+ESM-1预测脓毒症合并ARDS的临床价值。结果 观察组的NLRP3mRNA、HMGB1及ESM-1水平均高于脓毒症对照组、健康对照组,且脓毒症对照组高于健康对照组,差异有显著性(P<0.05)。Logistic回归分析显示,肺部感染、APACHEⅡ评分、NLRP3 mRNA、HMGB1、ESM-1均是脓毒症合并ARDS的影响因素。ROC曲线分析显示,ESM-1诊断脓毒症合并ARDS的最佳临界值为10.56,曲线下面积(area under the curve,AUC)为0.566(95%CI 1.655~2.297,P<0.001),灵敏度为70.35%,特异度为79.26%;HMGB1诊断脓毒症合并ARDS的最佳临界值为98.77,AUC为0.661(95%CI 1.769~2.436,P<0.001),灵敏度为72.41%,特异度为80.57%;NLRP3 mRNA+HMGB1+ESM-1联合诊断的灵敏度为85.96%,特异度为94.78%。结论 NLRP3炎症小体、HMGB1及ESM-1在脓毒症合并ARDS的诊断中具有临床价值,可作为评估患者预后的重要指标。Objective To study nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome,high mobility group protein B1(HMGB1)and endothelial cell specific molecule-1(ESM-1)in sepsis Diagnostic value in patients with acute respiratory distress syndrome(ARDS).Method The 87 patients with sepsis included in Yongchuan Hospital Affiliated to Chongqing Medical University from January 2021 to June 2021 were selected.Among them,36 patients with ARDS were selected as observation group,and the other 51 patients with simple sepsis were selected as sepsis control group.The other patients were selected to be in Yongchuan Hospital Affiliated to Chongqing Medical University during the same period.Forty-three healthy subjects under physical examination were used as healthy control group.NLRP3 mRNA,HMGB1 and ESM-1 were measured in each group,and the data of each group were counted.The logistic equation was selected to analyze the influencing factors of sepsis combined with ARDS,and the work characteristics of subjects(ROC)curve observation of the predictive value of HMGB1,ESM-1,NLRP3 mRNA+HMGB1+ESM-1 in sepsis with ARDS.Result The levels of NLRP3 mRNA,HMGB1 and ESM-1 in the observation group were higher than those in the sepsis control group and the healthy control group.Logistic regression analysis showed that pulmonary infection,APACHEⅡscore,NLRP3 mRNA,HMGB1,and ESM-1 were all influencing factors of sepsis complicated with ARDS.The results of ROC curve analysis showed that the best critical value of ESM-1 level in the diagnosis of ARDS caused by sepsis was 10.56,the AUC was 0.566(95%CI 1.655-2.297,P<0.001),the sensitivity was 70.35%,and the specificity was 70.35%.was 79.26%;the best critical value of HMGB1 level for diagnosing the disease was 98.77,the AUC was 0.661(95%CI 1.769-2.436,P<0.001),the sensitivity was 72.41%,and the specificity was 80.57%.NLRP3mRNA+HMGB1+ESM-1 has a sensitivity of 85.96%and a specificity of 94.78%.Conclusion NLRP3 inflammasome,HMGB1 and ESM-1 have clinical value in the diagnosis of s

关 键 词：脓毒症 核苷酸结合寡聚化结构域样受体蛋白3 高迁移率族蛋白1 内皮细胞特异性分子-1 肺部感染 急性呼吸窘迫综合征 

分 类 号：R631[医药卫生—外科学] R563.8[医药卫生—临床医学]