AECOPD合并肺炎患者外周血中焦亡因子的表达及血清化验指标联合PSI评分对病情的评估  

Expression level of peripheral blood pyroptosis factor in patients with AECOPD complicated with pneumonia and its combined with serum chemistries and pneumonia severity index in evaluating disease condition

作　　者：韩卓笑 马姣 范克新 孙同欣玮 孟爱宏[3] Han Zhuoxiao;Ma Jiao;Fan Kexin;Sun Tongxinwei;Meng Aihong(Department of Pulmonary and Critical Care Medicine,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China;Department of Pulmonary and Critical Care Medicine,Hebei PetroChina Central Hospital,Langfang 065000,China;Department of Pulmonary and Critical Care Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]秦皇岛市第一医院呼吸与危重症医学科,秦皇岛066000 [2]河北中石油中心医院呼吸与危重症医学科,廊坊065000 [3]河北医科大学第二医院呼吸与危重症医学科,石家庄050000

出　　处：《国际呼吸杂志》2025年第3期251-259,共9页International Journal of Respiration

基　　金：河北省自然科学基金京津冀基础研究合作专项(H2023206909);河北省自然科学基金精准医学联合基金重点项目(C2021206011)。

摘　　要：目的分析慢性阻塞性肺疾病急性加重期(AECOPD)合并肺炎患者外周血中焦亡因子的表达与疾病严重程度的关系,以及多重耐药菌感染对病情的影响,并探讨血清热休克蛋白90(HSP90)、白细胞介素6(IL-6)、降钙素原(PCT)联合肺炎严重指数(PSI)评分对AECOPD合并肺炎病情加重的评估价值。方法本研究为病例对照研究。采用目的抽样法,选取2022年1月至2024年1月河北医科大学第二医院收治的358例AECOPD合并肺炎患者为研究对象,按照AECOPD严重程度(是否合并呼吸衰竭)分为轻症组(186例)和重症组(172例)。入组当天清晨采集研究对象的外周静脉血,应用实时荧光定量聚合酶链反应和酶联免疫吸附试验检测胱天蛋白酶1(caspase-1)、GSDMD、HSP90的mRNA和蛋白表达水平。比较2组血清焦亡相关因子的表达和临床资料。通过多因素logistic回归分析AECOPD合并肺炎患者病情加重的影响因素,绘制HSP90、IL-6、PCT、PSI评分及四项联合的受试者操作特征(ROC)曲线,分析其评价AECOPD合并肺炎患者病情的预测效能。结果重症组的男性比例[91.9%(158/172)比74.7%(139/186),χ^(2)=18.55,P<0.001]、年龄[(68.61±11.37)岁比(63.37±7.98)岁,t=5.08,P<0.001]均高于轻症组。AECOPD合并肺炎患者血清HSP90水平高于正常参考值。重症组患者外周血中焦亡相关因子caspase-1、GSDMD、HSP90 mRNA的表达水平高于轻症组(t值分别为19.65、7.86、15.47,均P<0.001)。重症组患者外周血中焦亡相关因子caspase-1、GSDMD、HSP90蛋白的表达水平高于轻症组(t值分别为20.75、24.06、10.76,均P<0.001)。重症组的吸烟史比例[87.2%(150/172)比75.3%(140/186),χ^(2)=8.28,P<0.001]、低蛋白血症比例[59.3%(102/172)比38.7%(72/186),χ^(2)=15.70,P<0.001]、长期使用糖皮质激素比例[84.9%(146/172)比42.5%(79/186),χ^(2)=68.84,P<0.001]、多重耐药菌感染比例[57.0%(98/172)比18.8%(35/186),χ^(2)=55.73,P<0.001]、IL-6水平[(52.11±9.69)ng/L比(45.35±8.40ObjectiveTo analyze the expression level of peripheral blood pyroptosis-related factors and its correlation with the disease severity in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pneumonia and the impact of multiple drug-resistant bacterial infections on the disease condition,and to explore the potential of serum heat shock protein 90(HSP90),interleukin-6(IL-6),procalcitonin(PCT)combined with pneumonia severity index(PSI)in evaluating AECOPD complicated with pneumonia.MethodsThis was a case-control study.A total of 358 AECOPD patients complicated with pneumonia admitted to the Second Hospital of Hebei Medical University from January 2022 to January 2024 were selected using the purpose sampling method.They were divided into the mild group(186 cases)and the severe group(172 cases)according to the severity of AECOPD(whether to merge respiratory failure).Peripheral venous blood was collected early on the morning of admission day.Real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)and enzyme-linked immunosorbent assay(ELISA)were used to detect the mRNA and protein expression levels of Caspase-1,gasdermin-D(GSDMD),and HSP90.Serum pyroptosis-related factors and clinical data were compared between groups.Multivariate logistics regression analysis was conducted to analyze the influence factors for AECOPD complicated with pneumonia.The receiver operating characteristic curve(ROC)of HSP90,IL-6,PCT,PSI and their combination in predicting the disease condition of AECOPD complicated with pneumonia was plotted.ResultsThe male proportion(91.9%[158/172]vs 74.7%[139/186],χ^(2)=18.55,P<0.001]and age(68.61±11.37 years vs 63.37±7.98 years,t=5.08,P<0.001)in the severe group were significantly higher than those in the mild group.Compared with the average reference value of HSP90,serum HSP90 level of AECOPD patients with pneumonia significantly increased.The mRNA expression levels of Caspase-1,GSDMD,and HSP90 in the severe group were significantly higher than t

关 键 词：肺疾病 慢性阻塞性 慢性阻塞性肺疾病急性加重期 肺炎 焦亡 热休克蛋白90 细胞因子 

分 类 号：R563[医药卫生—呼吸系统]