蝮蛇咬伤对中性粒细胞NETs和炎症损伤影响的临床研究  

Clinical study on the effects of snake bites on neutrophil traps(NETs)and inflammatory damage

作　　者：余涛[1] 袁丞达[1] 杨敏[1] YU Tao;YUAN Chenda;YANG Min(Department of Dermatology,Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University,Hangzhou 310007,Zhejiang,China)

机构地区：[1]浙江中医药大学附属杭州市中医院皮肤科,浙江杭州3100071

出　　处：《中国现代医生》2024年第20期13-16,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2021RC114);浙江省中医药科技计划项目(2021ZB189)。

摘　　要：目的探讨蝮蛇咬伤后中性粒细胞胞外诱捕网(neutrophil extracellular traps,NETs)标志物嗜中性粒细胞弹性蛋白酶(neutrophil elastase,NE)以及细胞游离DNA(cell free DNA,cf-DNA)变化和与炎症标志物及组织损伤标志物的相关性。方法选取2021年9月—2022年12月杭州市中医院皮肤科收治的蝮蛇咬伤患者作为研究对象,研究包括36例蝮蛇咬伤患者,20例健康体检者;比较两组中性粒细胞、淋巴细胞计数、嗜中性粒细胞弹性蛋白酶(neutrophil elastase,NE)、细胞游离DNA(cell free DNA,cf-DNA)、血清淀粉样蛋白A(serum amyloid A,SAA)、C反应蛋白(C-reactive protein,CRP)、中性粒细胞淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、肌酸激酶(creatine kinase,CK)、肌酸肌酶同工酶(creatine kinase-MB,CKMB)、天门冬氨酸转氨酶(aspartic transaminase,AST)和乳酸脱氢酶(lactate dehydrogenase,LDH)水平,计算Pearson相关系数并利用Python软件编写代码绘制热力图、箱线图,分析中性粒细胞计数与NETs标志物、炎症标志物和组织损伤标志物之间的相关性。结果蝮蛇咬伤后中性粒细胞计数升高,NETs标志物NE、cf-DNA升高,CRP、SAA、NLR、AST升高,淋巴细胞计数降低。蝮蛇咬伤后中性粒细胞数值与NE酶、cf-DNA血清含量呈正相关,而与炎标志物CRP和SAA之间没有明显相关性;而CRP与SAA、CKMB与LDH强正相关,CK与NE、SAA与NE之间呈正相关,淋巴细胞数与NLR呈负相关。结论蝮蛇咬伤可能引起NETs水平上升,促进炎症加重和组织损伤。Objective To investigate the changes in neutrophils and their extracellular trap(NETs)markers,including neutrophil elastase(NE)and cell-free DNA(cf-DNA),after Gloydius brevicaudus biten and their correlation with inflammatory and tissue damage markers.Methods A total of 36 patients biten by Gloydius brevicaudus and 20 healthy individuals were included in the study from September 2021 to December 2022 at Hangzhou Hospital of Traditional Chinese Medicine.Neutrophil count,lymphocyte count,neutrophil-to-lymphocyte ratio(NLR),C-reactive protein(CRP),serum amyloid A(SAA),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase-MB(CKMB),cf-DNA,and NE levels were compared between the two groups.Pearson correlation coefficients were calculated,and a heatmap and boxplot were generated using Python software to analyze the correlation between neutrophil count and NETs markers,inflammatory markers,and tissue damage markers.Results After Gloydius brevicaudus biten,Neutrophil count,NE,cf-DNA,CRP,SAA,NLR,and AST were elevated,while lymphocyte count was decreased.There was a general positive correlation between Neutrophil count and NE,as well as cf-DNA/NETs serum levels.However,there was no significant correlation between Neutrophil count and inflammatory markers CRP and SAA.CRP was strongly positively correlated with SAA,and CKMB was strongly positively correlated with LDH.CK was highly positively correlated with NE and SAA was highly positively correlated with NE.Lymphocyte count had a strong negative correlation with NLR.Conclusion Gloydius brevicaudus biten may result in an increase in NETs levels in neutrophils,promoting inflammation exacerbation and tissue damage.

关 键 词：蝮蛇咬伤 中性粒细胞 中性粒细胞胞外诱捕网 血清淀粉样蛋白A 

分 类 号：R459.7[医药卫生—急诊医学]