摘要
目的 研究血清沉默信号调节因子1(SIRT1)、瓜氨酸化组蛋白H3(CitH3)检测在急性脓毒症患者病情及预后评估中的应用价值.方法 研究方法为回顾性分析,观察对象为2019年4月至2023年4月南京医科大学附属苏州医院收治入院的285例急性脓毒症患者,将其设为研究组,同时,选取同一时期入院接受体检的285名健康者,将其设为对照组.比较研究组与对照组的血清SIRT1、CitH3水平.并参考疾病严重程度将研究组分为A组(脓毒症,n=106)、B组(严重脓毒症,n=122)、C组(感染性休克,n=57);参考患者治疗1个月之后的存活状况予以分组,即存活组(n=217)、死亡组(n=68).比较A组、B组及C组,存活组与死亡组患者的血清SIRT1、CitH3水平;分析血清SIRT1、CitH3水平与序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)的相关性;采取多因素Logistic回归分析法分析影响脓毒症患者1个月死亡的危险因素.结果 研究组患者的血清SIRT1水平为(1.29 ±0.83)ng/mL,明显低于对照组[(4.81±1.48)ng/mL],CitH3 水平为(48.85±13.12)pg/mL,明显高于对照组[(5.81±1.23)pg/mL],差异均有统计学意义(P＜0.05).A、B 组患者的 SIRT1 水平分别为(1.84±1.03)、(1.23±0.72)ng/mL,均明显高于 C 组[(0.62±0.30)ng/mL],A、B 组患者的血清 CitH3 水平分别为(29.19±7.36)、(48.57±14.10)pg/mL,均明显低于C组[(76.89±25.15)pg/mL],差异均有统计学意义(P＜0.05).存活组患者的血清SIRT1水平为(1.61±0.92)ng/mL,明显高于死亡组[(0.50±0.24)ng/mL],CitH3 水平为(32.71±10.26)pg/mL,明显低于死亡组[(87.62±23.39)pg/mL],差异均有统计学意义(P＜0.05).Pearson相关性分析显示,血清SIRT1与SOFA、APACHEⅡ 评分均呈负相关(r=-0.484、-0.462,P＜0.05);血清 CitH3 与 SOFA、APACHE Ⅱ 评分均呈正相关(r=0.478、0.478,P＜0.05).脓毒症患者1个月死亡预测中SIRT1的受试者工作特征曲线下面积(AUC)、敏感度、特异度依次为0.852、0.741、0.838,CitH3的AUC、敏感度、特异度依次为0.827、0.709、0.773.多因素Logistic回归分析显示,血清SIRT1下降、CitH3上升和SOFA评分及APACHE Ⅱ评分为影响脓毒症患者1个月死亡的独立危险因素(P＜0.05).结论 急性脓毒症患者病情及预后评估中血清SIRT1、CitH3水平检测的应用价值显著,且血清SIRT1下降、CitH3上升是对脓毒症患者1个月死亡产生影响的独立危险因素,可用于辅助预测患者临床预后并为其诊治提供参考依据.
Abstract
Objective To investigate the application value of serum silenced signal regulator 1(SIRT1)and citrullinated histone H3(Ci-tH3)in the assessment of the condition and prognosis of patients with acute sepsis.Methods The study method was retrospective analysis,285 patients with acute sepsis admitted to The Affiliated Suzhou Hospital of Nanjing Medical University from April 2019 to April 2023 were set as the study group.At the same time,285 healthy patients admitted to hospital for physical examination were selected as the control group.The serum levels of SIRT1 and CitH3 in the study group and the control group were compared.The study group was divided into the group A(sepsis,n=106),the group B(severe sepsis,n=122)and the group C(septic shock,n=57)according to the severity of the disease.The survival status of patients after 1 month of treatment was divided into two groups,the namely survival group(n=217)and the death group(n=68).The ser-um SIRT1 and CitH3 levels of patients in groups A,B,C,the survival group and death group were compared.The correlation of serum SIRT1 and CitH3 levels with Sequential Organ failure score(SOFA)and acute physiology and chronic health evaluation scoring system(APACHE Ⅱ)was analyzed.Multivariate Logistic regression analysis was used to analyze the risk factors of 1-month death in patients with sepsis.Results The lev-el of serum SIRT1 in the study group was(1.29±0.83)ng/mL,which was significantly lower than that of the control group[(4.81±1.48)ng/mL],and the level of CitH3 was(48.85±13.12)pg/mL,which was significantly higher than that of the control group[(5.81±1.23)pg/mL],the differences were statistically significant(P＜0.05).The level of SIRT1 in the groups A and B was(1.84±1.03),(1.23±0.72)ng/mL,which was significantly higher than that in the group C[(0.62±0.30)ng/mL],the level of serum CitH3 in the groups A and B was(29.19±7.36),(48.57±14.10)pg/mL,which was significantly lower than that in the group C[(76.89±25.15)pg/mL],the differences were statistically significant(P＜0.05).The level of SIRT1 was(1.61±0.92)ng/mL,which was significantly higher than that in the death group[(0.50±0.24)ng/mL],and the level of serum CitH3 in the survival group was(32.71±10.26)pg/mL,which was significantly lower than that in the death group[(87.62±23.39)pg/mL],the differences were statistically significant(P＜0.05).Pearson correlation analysis showed that serum SIRT1 was negatively correlated with SOFA and APACHE Ⅱ score(r=-0.484,-0.462,P＜0.05).Serum CitH3 was positively correlated with SOFA and APACHE Ⅱ score(r=0.478,0.478,P＜0.05).In the one-month death prediction of sepsis patients,the subject area under the working characteristic curve(AUC),sensitivity and specificity of SIRT1 were 0.852,0.741 and 0.838,and the AUC sensitivity and specificity of CitH3 were 0.827,0.709 and 0.773,respectively.Multivariate Logistic regression analysis showed that the inde-pendent risk factors affecting the one-month death of sepsis patients were serum SIRT1 decrease,CitH3 increase,SOFA score,and APACHE Ⅱscore(P＜0.05).Conclusion Serum SIRT1 and CitH3 levels have significant application value in the assessment of the condition and progno-sis of patients with acute sepsis,and serum SIRT1 decrease,CitH3 increase are independent risk factors affecting the death of patients with sepsis within 1 month,which can be used to help predict the clinical prognosis of patients and provide a reference for diagnosis and treatment.
基金项目
江苏省妇幼健康资助项目(F202013)
南京医科大学姑苏学院科研项目(GSKY20210201)
维普
万方数据