血清S1P和HIF-1α水平与脓毒症患者肠屏障状况及临床预后的关系  

Relationship between serum S1P and HIF-1αlevels and intestinal barrier status and clinical prognosis in patients with sepsis

作　　者：费露颍 钱义明[1] 沙媛媛[1] 郭健[1] 胡冠宇 FEI Luying;QIAN Yiming;SHA Yuanyuan;GUO Jian;HU Guanyu(Department of Emergency Medicine,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院急诊医学科,上海200437

出　　处：《热带医学杂志》2024年第5期680-684,F0003,共6页Journal of Tropical Medicine

基　　金：上海市科学技术委员会科技计划项目(23ZR1464200)。

摘　　要：目的探究脓毒症患者血清1-磷酸鞘氨醇(S1P)、低氧诱导因子-1α(HIF-1α)水平变化,及与患者肠屏障状况、临床预后的关系。方法选取2021年3月-2023年3月在上海中医药大学附属岳阳中西医结合医院治疗的125例确诊的脓毒症患者为病例组,根据病情分为重度组(37例)、中度组(47例)和轻度组(41例),根据预后情况分为死亡组(41例)和生存组(84例),选取同期125名体检健康者为对照组。比较血清S1P、HIF-1α水平。Logistic回归分析患者死亡的影响因素。受试者工作特征(ROC)曲线分析血清S1P、HIF-1α水平对患者死亡的预测价值。结果病例组血清S1P水平明显低于对照组,HIF-1α水平明显高于对照组,差异均有统计学意义(t=10.479、13.720,P均<0.05)。随病情发展,血清S1P依次降低,HIF-1α、二胺氧化酶(DAO)、肠脂肪酸结合蛋白(IFABP)、D-乳酸(D-LAC)水平依次升高,差异均有统计学意义(F=29.935、46.556、31.998、30.241、42.705,P均<0.05)。血清S1P水平与DAO、IFABP、D-LAC均成负相关(r=-0.589、-0.622、-0.599,P均<0.05),血清HIF-1α水平与DAO、IFABP、D-LAC均成正相关(r=0.608、0.612、0.682,P均<0.05)。死亡组HIF-1α、IL-6、高迁移率族蛋白B1(HMGB1)水平明显高于生存组,S1P水平明显低于生存组,差异均有统计学意义(t=6.016、12.273、4.040、6.922,P均<0.05)。S1P为患者死亡的独立保护因素(P<0.05),HIF-1α、IL-6、HMGB1为患者死亡的独立危险因素(P<0.05);血清S1P、HIF-1α水平预测患者死亡的曲线下面积(AUC)分别为0.839、0.824,二者联合预测的AUC为0.930,二者联合预测优于S1P、HIF-1α单独预测(Z=2.415、3.334,P=0.016、0.001)。结论脓毒症患者血清S1P水平下调,HIF-1α水平上调,且二者表达水平与肠屏障状况密切相关,二者联合预测预后具有更高的价值。Objective To investigate the relationship between serum levels of sphingosine-1-phosphate(S1P) and hypoxia inducible factor-1α(HIF-1α) with intestinal barrier condition and clinical prognosis in patients with sepsis. Methods A total of 125 confirmed sepsis patients treated in our hospital from March 2021 to March 2023 were collected as the case group. They were separated into severe group(37 cases), moderate group(47 cases), and mild group(41 cases) based on their condition. They were separated into death group(41 cases) and survival group(84 cases) based on their prognosis.125 healthy individuals who underwent physical examination were regarded as the control group. Serum S1P and HIF-1αlevels were compared. Logistic regression was applied to analyze the influencing factors of death. Receiver operating characteristic(ROC) curve was applied to analyze the predictive value of serum S1P and HIF-1α levels for death. Results The serum S1P level in the case group was obviously lower than that in the control group, and the HIF-1α level was obviously higher than that in the control group, all the differences were statistically significant(t=10.479, 13.720;all P<0.05). As the disease progressed, serum S1P decreased sequentially, while levels of HIF-1α, diamine oxidase(DAO),intestinal fatty-acid binding protein(IFABP), and D-lactic acid(D-LAC) increased sequentially,all the differences were statistically significant(F=29.935, 46.556, 31.998, 30.241, 42.705;all P<0.05). The serum S1P level was negatively correlated with DAO, IFABP, and D-LAC(r=-0.589,-0.622,-0.599;all P<0.05), while the serum HIF-1α level was positively correlated with DAO, IFABP, and D-LAC(r=0.608, 0.612, 0.682;all P<0.05). The levels of HIF-1α, IL-6, and high mobility group box-1 protein(HMGB1) in the death group were obviously higher than those in the survival group;all the differences were statistically significant(t=6.016, 12.273, 4.040;all P<0.05), and the levels of S1P were obviously lower than those in the survival group(t=6.922, P<0.05). S1

关 键 词：脓毒症 1-磷酸鞘氨醇 低氧诱导因子-1Α 肠屏障状况 

分 类 号：R459.7[医药卫生—急诊医学]