目的 研究脓毒症相关急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者血清焦亡蛋白的变化及意义。 方法 本研究为病例对照研究。采用非随机抽样法，选择2020年1月至2022年12月河北北方学院附属第一医院收治的脓毒症200例患者作为研究对象，根据脓毒症患者是否合并ALI/ARDS分为脓毒症非ALI/ARDS组(116例)与脓毒症ALI/ARDS组(84例)，根据脓毒症ALI/ARDS患者28 d预后情况分为生存组(52例)和死亡组(32例)。检测血清焦亡蛋白半胱氨酸天冬氨酸蛋白水解酶1(Caspase-1)、Gasdermin-D(GSDMD)水平，采用logistic回归分析脓毒症ALI/ARDS患者死亡的影响因素，采用受试者工作特征(ROC)曲线分析脓毒症ALI/ARDS患者死亡的预测指标。 结果 脓毒症ALI/ARDS组患者的血清Caspase-1、GSDMD-N水平均高于脓毒症非ALI/ARDS组。分别为Caspase-1[(1 181。25±320。31) ng/L比(913。58±201。46) ng/L]；GSDMD-N (8。87±1。59) μg/L比(7。14±1。24) μg/L；(均P<0。05)；死亡组脓毒症ALI/ARDS患者的血清Caspase-1、GSDMD-N、肌酐及急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分均高于存活组。分别为Caspase-1 [(1 411。53±325。78) ng/L比(1 039。55±220。2) ng/L；GSDMD-N (10。35±1。55) μg/L比(7。97±0。67) μg/L；APACHE Ⅱ [(27。50±3。75)分比(21。15±4。70)分。(均P<0。05)；logistic回归分析显示，血清Caspase-1、GSDMD-N、APACHEⅡ评分是脓毒症ALI/ARDS患者死亡的影响因素(均P<0。05)；ROC曲线分析显示，血清Caspase-1(95%CI：0。76～0。93)、GSDMD-N(95%CI：0。88～1。00)及APACHEⅡ评分(95%CI：0。76～0。95)对脓毒症ALI/ARDS患者的死亡具有预测效能，三项指标联合(平行试验)预测的敏感度和特异度分别为96。88%和92。31%。 结论 脓毒症相关ALI/ARDS患者血清焦亡蛋白Caspase-1、GSDMD-N显著增加，且其联合APACHEⅡ评分对患者死亡具有良好的预测效能。 Objective To study the changes and significance of serum pyroptosis protein of patients with sepsis associated acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)。 Methods This was a case-control study。Using non-random sampling method， 200 cases of sepsis patients admitted to the First Affiliated Hospital of Hebei North University from January 2020 to December 2022 were selected as the study subjects。Sepsis patients were divided into sepsis non-ALI/ARDS group (n=116) and sepsis ALI/ARDS group (n=84) according to whether they were combined with ALI/ARDS。Sepsis ALI/ARDS patients were further divided into survival group (n=52) and death group (n=32) according to the 28 d prognosis。The levels of cysteinyl aspartate specific proteinase-1 (Caspase-1) and Gasdermin-D (GSDMD) in serum were detected。The influencing factors of death in patients with sepsis ALI/ARDS were analyzed by logistic regression and the predictive indicators of death were analyzed by receiver operating characteristic (ROC) curve。 Results The levels of serum Caspase-1 and GSDMD-N in sepsis ALI/ARDS group were higher than those in sepsis non-ALI/ARDS group。Caspase-1 was (1 181。25±320。31) ng/L vs (913。58±201。46) ng/L GSDMD-N was (8。87±1。59) μg/L vs (7。14±1。24) μg/L。(all P<0。05)。 The levels of serum Caspase-1， GSDMD-N， creatinine， and acute physiological and chronic health evaluation Ⅱ (APACHEⅡ) scores of sepsis ALI/ARDS patients in the death group were higher than those in the survival group Caspase-1 was (1 411。53±325。78 ) ng/Lvs (1 039。55±220。2) ng/L GSDMD-N was (10。35±1。55) μg/L vs (7。97±0。67) μg/L APACHE Ⅱ was (27。50±3。75) vs (21。15±4。70) points。(all P<0。05)。 Logistic regression analysis showed that serum Caspase-1， GSDMD-N， and APACHEⅡ scores were the influencing factors for the death of sepsis ALI/ARDS patients (allP<0。05)。 ROC curve analysis showed that serum Caspase-1 (95%CI: 0。76-0。93)， GSDMD-N (95% CI: 0。88-1。00)， and APACHEⅡ scores (95% CI: 0。76-0。95) were effective in predicting the death of sepsis ALI/ARDS patients， and the combined prediction sensitivity and specificity of the three indexes were 96。88% and 92。31% respectively。 Conclusions Serum pyroptosis protein Caspase-1 and GSDMD-N significantly increase in patients with sepsis associated with ALI/ARDS， and combined with APACHEⅡ score the two factors show a good predictive efficacy on patient death。
Expression and significance of serum pyroptosin in patients with sepsis associated acute respiratory distress
Objective To study the changes and significance of serum pyroptosis protein of patients with sepsis associated acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Methods This was a case-control study.Using non-random sampling method, 200 cases of sepsis patients admitted to the First Affiliated Hospital of Hebei North University from January 2020 to December 2022 were selected as the study subjects.Sepsis patients were divided into sepsis non-ALI/ARDS group (n=116) and sepsis ALI/ARDS group (n=84) according to whether they were combined with ALI/ARDS.Sepsis ALI/ARDS patients were further divided into survival group (n=52) and death group (n=32) according to the 28 d prognosis.The levels of cysteinyl aspartate specific proteinase-1 (Caspase-1) and Gasdermin-D (GSDMD) in serum were detected.The influencing factors of death in patients with sepsis ALI/ARDS were analyzed by logistic regression and the predictive indicators of death were analyzed by receiver operating characteristic (ROC) curve. Results The levels of serum Caspase-1 and GSDMD-N in sepsis ALI/ARDS group were higher than those in sepsis non-ALI/ARDS group.Caspase-1 was (1 181.25±320.31) ng/L vs (913.58±201.46) ng/L GSDMD-N was (8.87±1.59) μg/L vs (7.14±1.24) μg/L.(all P<0.05). The levels of serum Caspase-1, GSDMD-N, creatinine, and acute physiological and chronic health evaluation Ⅱ (APACHEⅡ) scores of sepsis ALI/ARDS patients in the death group were higher than those in the survival group Caspase-1 was (1 411.53±325.78 ) ng/Lvs (1 039.55±220.2) ng/L GSDMD-N was (10.35±1.55) μg/L vs (7.97±0.67) μg/L APACHE Ⅱ was (27.50±3.75) vs (21.15±4.70) points.(all P<0.05). Logistic regression analysis showed that serum Caspase-1, GSDMD-N, and APACHEⅡ scores were the influencing factors for the death of sepsis ALI/ARDS patients (allP<0.05). ROC curve analysis showed that serum Caspase-1 (95%CI: 0.76-0.93), GSDMD-N (95% CI: 0.88-1.00), and APACHEⅡ scores (95% CI: 0.76-0.95) were effective in predicting the death of sepsis ALI/ARDS patients, and the combined prediction sensitivity and specificity of the three indexes were 96.88% and 92.31% respectively. Conclusions Serum pyroptosis protein Caspase-1 and GSDMD-N significantly increase in patients with sepsis associated with ALI/ARDS, and combined with APACHEⅡ score the two factors show a good predictive efficacy on patient death.
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