维生素 D 结合蛋白基因多态性对重症急性胰腺炎易感性及预后的影响  

Effect of vitamin D binding protein gene polymorphism on susceptibility and prognosis of severe acute pancreatitis

作　　者：李永元 丁元林[1] 井树森 苏锋[1] 邵建平[1] Li Yongyuan;Ding Yuanlin;Jing Shusen;Su Feng;Shao Jianping(Department of General Surgery,Tianjin Fifth Central Hospital,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院普外科,天津300450

出　　处：《中华危重病急救医学》2023年第10期1058-1062,共5页Chinese Critical Care Medicine

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-079D);北京康盟慈善基金会医学科研发展基金(WS694H)。

摘　　要：目的:探讨维生素D结合蛋白(DBP)基因多态性对重症急性胰腺炎(SAP)易感性及预后的影响。方法:采用前瞻性研究方法,选择2018年3月至2021年3月天津市第五中心医院普外科收治的83例SAP患者作为研究对象,同时选择同期83例体检健康者作为对照。提取入组对象外周血RNA并反转录为cDNA,使用荧光定量分析仪检测DBP基因rs7041位点基因型和等位基因频率;对基因多态性进行Hardy-Weinberg遗传平衡检验。SAP患者于入院当天采用散射免疫比浊法检测血清C-反应蛋白(CRP)水平,采用电化学发光法检测血清降钙素原(PCT)水平,采用酶联免疫吸附试验(ELISA)检测血清DBP水平,并计算中性粒细胞与淋巴细胞比值(NLR);统计入组患者重症监护病房(ICU)住院时间、总住院时间和住院期间的预后。采用多因素Logistic回归分析筛选发生SAP的影响因素。结果:Hardy-Weinberg遗传平衡检验结果显示,两组研究对象基因多态性分布均符合遗传平衡规律。SAP组患者DBP基因rs7041位点携带TT基因型和T等位基因的频率均明显高于健康对照组〔TT基因型:34.94%(29/83)比9.64%(8/83),T等位基因:55.42%(92/166)比38.55%(64/166),均 P<0.01〕,GT基因型频率明显低于健康对照组〔40.96%(34/83)比57.83%(48/83), P<0.05〕;而健康对照组与SAP组GG基因型频率差异无统计学意义〔32.53%(27/83)比24.10%(20/83), P>0.05〕。进一步多因素Logistic回归分析显示,DBP基因rs7041位点携带TT基因型〔优势比( OR)=2.831,95%可信区间(95% CI)为1.582~5.067, P<0.001〕和T等位基因( OR=2.533,95% CI为1.435~4.472, P<0.001)是健康人群发生SAP的独立危险因素,而携带GT基因型是发生SAP的保护因素( OR=0.353,95% CI为0.143~0.868, P=0.041)。SAP患者中,DBP基因rs7041位点携带TT基因型者入院当天CRP、PCT、NLR和DBP水平均明显高于携带GG/GT基因型者〔CRP(mg/L):43.25±13.25比31.86±12.83,PCT(μg/L):1.53±0.24比1.21±0.20,NLR:3.15±0.53比2.71±0.48,DBObjectiveTo investigate the effect of vitamin D binding protein(DBP)gene polymorphism on susceptibility and prognosis of severe acute pancreatitis(SAP).MethodsA prospective study was conducted.Eighty-three patients with SAP who were admitted to the department of general surgery of Tianjin Fifth Central Hospital from March 2018 to March 2021 were selected as the research objects,and 83 healthy people in the same period were selected as controls.Peripheral blood RNA was extracted and reverse transcribed into cDNA,and the genotype and allele frequency of DBP gene rs7041 locus were detected by fluorescence quantitative analyzer.Hardy-Weinberg equilibrium was used to test the genetic balance.On the day of admission,serum C-reactive protein(CRP)level was detected by scattering immunoturbidimetry,serum procalcitonin(PCT)level was detected by electrochemiluminescence,serum DBP level was detected by enzyme-linked immunosorbent assay(ELISA),and neutrophil to lymphocyte ratio(NLR)was calculated automatically by the instrument.The length of intensive care unit(ICU)stay,the length of hospital stay and prognosis during hospitalization of patients were statistically analyzed.Multivariate Logistic regression analysis was used to screen the influencing factors of SAP occurrence.ResultsThe results of Hardy-Weinberg equilibrium test showed that the distribution of gene polymorphisms in the two groups of subjects conformed to the law of genetic equilibrium.The frequencies of TT genotype and T allele of DBP gene rs7041 locus in the patients of SAP group were significantly higher than those in the healthy control group[TT genotype:34.94%(29/83)vs.9.64%(8/83),T allele:55.42%(92/166)vs.38.55%(64/166),both P<0.01],and the frequency of GT genotype was significantly lower than that in the healthy control group[40.96%(34/83)vs.57.83%(48/83),P<0.05].There was no significant difference in the frequency of GG genotype between the healthy control group and SAP group[32.53%(27/83)vs.24.10%(20/83),P>0.05].Further multivariate Logistic regression

关 键 词：重症急性胰腺炎 维生素D结合蛋白 基因多态性 病情严重程度 预后 

分 类 号：R576[医药卫生—消化系统]