发热伴血小板减少综合征中补体C5a参与炎症因子风暴及对预后的判断价值  

The involvement of complement C5a in inflammatory cytokine storm and its prognostic value in severe fever with thrombocytopenia syndrome

作　　者：王大成 曹科[1] 段剑峰 李孝尧 陈鸣[1] 虞文魁 WANG Dacheng;CAO Ke;DUAN Jianfeng;LI Xiaoyao;CHEN Ming;YU Wenkui(Intensive Care Unit,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院重症医学科,江苏南京210008

出　　处：《西部医学》2022年第12期1772-1776,共5页Medical Journal of West China

基　　金：国家自然基金(82002082);2020年江苏省“双创博士”课题(N0.76523900)。

摘　　要：目的探讨补体C5a在发热伴血小板减少综合征(SFTS)的炎症因子风暴和预测疾病严重程度的作用。方法回顾性分析2017年~2021年我院收治的SFTS患者,根据SFTS病情分级,将其分为轻症组(n=73)、重症组(n=21)、危重症组(n=28)。分析患者的一般临床资料、实验室检查指标进行相关性分析,使用Pearson或Spearman相关检验对补体C5a与实验室检查指标,使用连续动态分析(GEE)来进行分析补体C5a的变化,使用受试者工作特征(ROC)曲线下面积评估C5a对于疾病严重程度和预后的作用。结果重症组和危重症组的血清补体C5a水平明显高于轻症组,SFTS患者的补体C5a水平与IL-6呈正相关性(r=0.246,P=0.0024),与TNF-α水平呈正相关(r=0.261,P=0.0017),与严重评分水平呈正相关(r=0.4757,P<0.001)。补体C5a的动态分析显示轻症组的补体C5a水平呈现动态平衡,低于正常水平,而重症组的补体C5a水平呈现持续下降的趋势,危重症组患者的补体C5a水平持续位于高位。补体C5a预测SFTS疾病严重程度的AUC曲线下面积为0.9332(95%CI:0.8438~0.9692,P<0.001),预测SFTS预后的AUC曲线面积为0.8946(95%CI:0.8218~0.9341,P<0.001)。结论补体C5a参与了SFTS患者的炎症因子风暴,可以有效预测SFTS患者的疾病严重程度和预后。Objective To investigate the role of complement C5a in inflammatory cytokine storm of severe fever with thrombocytopenia syndrome(SFTS)and predict the severity of disease.Methods Patients with SFTS admitted from 2017 to 2021 were retrospectively analyzed,and their general clinical data and laboratory test indicators were analyzed.Pearson or Spearman correlation test was used to analyze the changes of complement C5a and laboratory test indicators,and continuous dynamic analysis(GEE)was used to analyze the changes of complement C5a.Area under the Receiver operating characteristic(ROC)curve was used to assess the effect of C5a on disease severity and prognosis.Results The level of complement C5a in the severe and critical groups was significantly higher than that in the general group(376.2±66.4,404.2±75.3 vs 220.47±45.34),and there were a positive correlation between the complement C5a level and il-6 in SFTS patients(r=0.246,P=0.0024),a positively correlation with TNF-αlevel(r=0.261,P=0.0017),and a positively correlation with severity score(r=0.4757,P<0.001).According to the dynamic analysis of complement C5a,the complement C5a level of the normal group showed a dynamic balance,lower than the normal level,while the complement C5a level of the severe group showed a continuous downward trend,and the complement C5a level of the critically ill group remained high.The AUC curve area of complement C5a in predicting the severity of SFTS was 0.9332(95%CI:0.8438-0.9692,P<0.001),and the AUC curve area in predicting the prognosis of SFTS was 0.8946(95%CI:0.8218-0.9341,P<0.001).Conclusion Complement C5a is involved in the inflammatory factor storm of SFTS patients and can effectively predict the disease severity and prognosis of SFTS patients.

关 键 词：发热伴血小板减少综合征 补体系统 炎症因子风暴 预测价值 

分 类 号：R558[医药卫生—血液循环系统疾病]