摘要
目的探讨脓毒症补体成分3A受体1(C3AR1)及巨噬细胞细胞因子与心脏损伤及预后的关系。方法将106例脓毒症患者按是否存在脓毒症诱导的心肌功能障碍(SIMD)分为SIMD组21例和非SIMD组85例。采用连续器官衰竭评估(SOFA)量表对患者进行SOFA评分。使用Milliplex MAP试剂盒测定患者血浆人粒细胞集落刺激因子(G-CSF)、C3A和肿瘤坏死因子-α(TNF-α)水平,使用PCR法检测外周血单个核细胞(PBMCs)中C3AR1 mRNA的表达,使用血液分析仪检测节状中性粒细胞-单核细胞比率(SeMo)。采用Logistic回归分析评估与SIMD相关的免疫功能参数,采用生成受试者操作曲线(ROC)评估免疫功能参数组合评分和SOFA评分预测SIMD的效果。结果与非SIMD组相比,SIMD组SeMo显著降低(P<0.05),SOFA评分、TNF-α、G-CSF、C3A、C3AR1水平显著增加(P<0.05)。Logistic回归分析显示,SeMo、G-CSF、C3A和C3AR1是SIMD的独立预测因素;按β回归系数值确定的各免疫功能参数风险评分的组合评分:0、1、2、3、4、5、6、7、8分的SIMD发生率分别为0.0%(0/20)、4.5%(1/22)、0.0%(0/6)、13.3%(2/15)、20.8%(5/24)、61.5%(8/13)、0.0%(0/1)、100.0%(4/4)、100.0%(1/1),组间比较差异具有统计学意义(χ^(2)=44.796,P<0.001)。ROC分析显示,免疫功能参数组合评分预测SIMD的AUC为0.862、敏感度为66.7%、特异度为90.6%,显著高于SOFA评分的0.725、61.9%、75.3%(P<0.001)。结论免疫功能参数组合评分结合了血浆G-CSF水平、C3A水平、血清SeMo比率和单核细胞C3AR1表达水平,在预测SIMD方面优于SOFA评分。
Objective To explore the relationship of the expression levels of complement component 3A receptor 1(C3AR1)and macrophage cytokines with cardiac injury and its prognosis in patients with sepsis.Methods 106 patients with sepsis were divided into a sepsis-induced myocardial dysfunction(SIMD)group with 21 cases and a non-SIMD group with 85 cases,according to the presence or absence of SIMD.The patients were scored with the sequential organ failure assessment(SOFA)scale.The levels of cytokines in plasma,including human granulocyte colony-stimulating factor(G-CSF),C3A and tumor necrosis factor-α(TNF-α),were quantified by Milliplex MAP kit.The expression of C3AR1 mRNA in peripheral blood mononuclear cells(PBMCs)was analyzed by PCR,and the segmented neutrophil-to-monocyte ratio(SeMo)was determined using a blood analyzer.Logistic regression analysis was employed to evaluate immune function parameters associated with SIMD.The predictive performance of a combination of immune function parameters and SOFA scores for SIMD was assessed by generating receiver operating characteristic(ROC)curves.Results Compared to the non-SIMD group,the SIMD group showed a significant decrease in SeMo(P<0.05)and significant increases in SOFA score,TNF-α,G-CSF,C3A,and C3AR1 levels(P<0.05).Logistic regression analysis revealed that SeMo,G-CSF,C3A,and C3AR1 were independent predictors of SIMD.The combined score of each patient was calculated by summing the risk scores of each parameter determined according to the value ofβregression coefficient:the incidence rates of SIMD corresponding to composite scores of 0,1,2,3,4,5,6,7,and 8 were 0.0%(0/20),4.5%(1/22),0.0%(0/6),13.3%(2/15),20.8%(5/24),61.5%(8/13),0.0%(0/1),100.0%(4/4),and 100.0%(1/1),respectively;the differences between groups were statistically significant(χ^(2)=44.796,P<0.001).ROC analysis demonstrated that the combined score of immune function parameters predicted SIMD with an AUC of 0.862,sensitivity of 66.7%,and specificity of 90.6%,which were significantly higher than the SOFA score with an AUC of 0.725,sensitivity of 61.9%,and specificity of 75.3%(P<0.001).Conclusion The immune function scoring system developed in this study,which combined plasma G-CSF levels,C3A levels,serum SeMo ratios,and monocyte C3AR1 expression levels,demonstrated superiority over the SOFA scoring in predicting SIMD.
作者
李欣
徐建博
杜娟
LI Xin;XU Jian-bo;DU Juan(Department of General Medicine,Jiamusi City Central Hospital,Jiamusi 154002,China;Department of Critical Care Medicine,Hanchuan City People’s Hospital,Hanchuan 432300,China)
出处
《南昌大学学报(医学版)》
2025年第1期69-75,共7页
Journal of Nanchang University:Medical Sciences
基金
黑龙江省卫生健康科研基金项目(2021030112474)
孝感市自然科学计划项目(XGKJ2022010066)。
关键词
脓毒症
补体成分3A受体1
外周血单核细胞
心脏损伤
免疫功能
sepsis
complement component 3A receptor 1
peripheral blood mononuclear cell
cardiac injury
immune function
