Relationship of MBL2 and HLA-DRB1 gene expression and alveolar macrophage phenotype of pulmonary infection-associated sepsis
Objective To investigate the expression levels of mannose-binding lectin 2(MBL2)and human leukocyte antigen(HLA)-DRB1 genes in children with pulmonary infection-associated sepsis,evaluate the changes in alveolar macrophage(AM)phenotypes in alveolar lavage fluid(BALF),and analyze the relationship of gene expression levels and AM phenotypes with the prognosis of children with sepsis.Methods A total of 122 children with pulmonary infection-associated sepsis admitted to the Children's Medical Center,Shiyan Taihe Hospital,from June 2019 to June 2021 were selected,and divided into sepsis group(n=57)and non-sepsis group(n=65)according to the presence or absence of sepsis.Children in the sepsis group were divided into death group(n=11)and survival group(n=46)according to the 28-day prognosis.The expression of MBL2 and HLA-DRB1 genes in peripheral blood was detected by real-time fluorescent quantitative PCR method,and AM phenotypes in alveolar lavage fluid were detected by flow cytometry.Results The relative expression of MBL2 mRNA was(0.35±0.08),higher than that of the non-sepsis group(0.24±0.07)(t=4.440,P＜0.001);the relative expression of HLA-DRB1 mRNA was(0.25±0.08),lower than that of the non-sepsis group(0.59±0.032)(t=8.632,P＜0.001);the difference was statistically significant.The relative expression level of MBL2 mRNA in peripheral blood of the sepsis group was higher than that in the non-sepsis group(t=4.440,P＜0.001),and the relative expression level of HLA-DRB1 mRNA was lower than that in the non-sepsis group(t=8.632,P＜0.001).The proportion of M1 type AM was higher and the proportion of M2 type AM was lower in the sepsis group than in the non-sepsis group on admission(t=3.161,7.748;all P＜0.05).The relative expression level of MBL2 mRNA in peripheral blood of the survival group was lower than that in the death group(t=3.950,P＜0.001),and the relative expression level of HLA-DRB1 mRNA was higher than that in the death group(t=3.327,P=0.002).On the 1st day after confirmed diagnosis,the proportion of M2 type AM in the survival group was significantly lower than that in the death group(t=18.135,P＜0.001),but there was no significant difference in the proportion of M1 type AM between the 2 groups(t=0.935,P=0.354).On the 7th day after confirmed diagnosis,the proportion of M1 type AM in the survival group was significantly lower than that in the death group(t=6.014,P＜0.001),and the proportion of M2 type AM was significantly higher than that in the death group(t=4.999,P＜0.001).Logistic regression analysis showed that MBL2 and HLA-DRB1 gene expression and the 7th day after confirmed diagnosis M1 and M2 type AM were significantly correlated with poor prognosis of the children(P=0.003,0.033,0.001,0.040).Conclusions MBL2 and HLA-DRB1 gene expression and AM phenotype were related to pulmonary infection-associated sepsis and the prognosis of children.Early dynamic monitoring of MBL2 and HLA-DRB1 gene expression and alveolar macrophage phenotype was helpful for predicting pulmonary infection-associated sepsis and 28-day prognosis.
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