脓毒症所致胃肠功能障碍患者血清热休克蛋白70、血红素加氧酶-1水平变化及其对病情的影响  

Changes of serum heat shock protein 70 and heme oxygenase-1 in patients with sepsis-induced gastrointestinal dysfunction and influence on disease conditions

作　　者：孙阿巧 李敏玲[1] 谭文君[1] 宋晔[1] 张云玲 宋银雪 Sun Aqiao;Li Minling;Tan Wenjun;Song Ye;Zhang Yunling;Song Yinxue(Emergency Center,The First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院急诊中心,710061

出　　处：《疑难病杂志》2025年第4期403-406,417,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省重点研发计划项目(20213-YBSF-421)。

摘　　要：目的探究脓毒症所致胃肠功能障碍患者血清热休克蛋白70(HSP70)、血红素加氧酶-1(HO-1)水平变化及意义。方法选取2021年2月—2024年2月西安交通大学第一附属医院急诊中心就诊的脓毒症所致胃肠功能障碍患者98例为功能障碍组,另选取同期于医院接受治疗的未合并胃肠功能障碍的脓毒症患者94例为无功能障碍组。采用酶联免疫吸附法测定血清HSP70、HO-1水平;Spearman秩相关分析血清HSP70、HO-1水平与病情严重程度的相关性;多因素Logistic回归分析脓毒症患者合并胃肠功能障碍的影响因素;受试者工作特征(ROC)曲线评价血清HSP70、HO-1水平对脓毒症患者合并胃肠功能障碍的预测价值。结果功能障碍组血清HSP70水平高于无功能障碍组,血清HO-1水平低于无功能障碍组(t/P=6.984/<0.001、7.404/<0.001);急性胃肠损伤分级Ⅲ~Ⅳ级患者的血清HSP70水平高于Ⅰ~Ⅱ级患者,HO-1水平低于Ⅰ~Ⅱ级患者(t/P=3.605/0.001、2.148/0.034);Spearman秩相关分析显示,血清HSP70水平与胃肠功能障碍程度呈正相关,HO-1水平与胃肠功能障碍程度呈负相关(r/P=0.317/0.002,-0.243/0.017);多因素Logistic回归分析显示,血清HSP70水平高是脓毒症患者合并胃肠功能障碍的独立危险因素[OR(95%CI)=1.014(1.008~1.020)],血清HO-1水平高是保护因素[OR(95%CI)=0.991(0.987~0.995)];血清HSP70、HO-1水平单独及二者联合预测脓毒症患者合并胃肠功能障碍的曲线下面积(AUC)分别为0.760、0.733、0.914,二者联合优于各自单独预测效能(Z/P=4.799/<0.001、5.822/<0.001)。结论血清HSP70、HO-1水平是影响脓毒症所致胃肠功能障碍发生的重要指标,早期测定二者水平对脓毒症所致胃肠功能障碍的发生风险具有较高预测价值。Objective To explore the changes and significance of serum heat shock protein 70(HSP70)and heme oxygenase-1(HO-1)in patients with sepsis-induced gastrointestinal dysfunction.Methods Ninety-eight patients with sepsis-induced gastrointestinal dysfunction in Emergency Center of the First Affiliated Hospital of Xi’an Jiaotong University from February 2021 to February 2024 were selected as the study group,and 94 patients with sepsis but without gastrointestinal dysfunction who received treatment during the same period were included in the control group.Serum HSP70 and HO-1 levels were determined by enzyme-linked immunosorbent assay.The correlation between serum HSP70 and HO-1 levels and disease severity was analyzed.The influence of serum HSP70 and HO-1 on gastrointestinal dysfunction was analyzed by multivariate Logistic regression analysis.The predictive value of serum HSP70 and HO-1 levels on gastrointestinal dysfunction in patients with sepsis was evaluated by receiver operating characteristic curve(ROC).Results Serum HSP70 level in the study group was higher while serum HO-1 level was lower compared to the control group(t=6.984,7.404,P<0.001).Serum HSP70 level in grade III-IV patients was higher than that in grade I-II patients while serum HO-1 level was lower(t=3.605,2.148,P<0.05).Spearman rank correlation analysis suggested that serum HSP70 level was positively correlated with the degree of gastrointestinal dysfunction,and HO-1 level was negatively associated with gastrointestinal dysfunction degree(r=0.317,-0.243,P=0.002,0.017).Multivariate Logistic regression analysis indicated that high serum HSP70 level was an independent risk factor for gastrointestinal dysfunction[OR(95%CI)=1.014(1.008-1.020)],and high serum HO-1 level was a protective factor[OR(95%CI)=0.991(0.987-0.995)].The areas under the curves(AUCs)of serum HSP70 and HO-1 alone and in combination were 0.760,0.733 and 0.914,and the AUC of HSP70 combined with HO-1 was better than that of HSP70 or HO-1 alone(Z=4.799,5.822,P<0.001).Conclusion Serum HSP

关 键 词：脓毒症 胃肠功能障碍 热休克蛋白70 血红素加氧酶-1 病情 预测价值 

分 类 号：R631[医药卫生—外科学] R57[医药卫生—临床医学]