1、*基金项目:安徽省自然科学基金项目(1808085MH228)通信作者:邵敏，E mail:shaominmail yahoo com脓毒症患者外周血单核细胞 mi 147b 的表达及其与病情严重程度和预后的关系*胡浩1，张胜利2，邵敏11安徽医科大学第一附属医院重症医学科(安徽合肥 230022);2中国人民解放军海军安庆医院重症监护室(安徽安庆 246000)【摘要】目的探讨脓毒症患者外周血单核细胞 mi 147b 的表达水平及其与病情严重程度及预后的相关性。方法选择 2019 年 1 月至 2021 年 6 月于安徽医科大学第一附属医院就诊的 46 例脓毒症患者(脓毒症组)和 50 例普
2、通感染患者(普通感染组)作为研究对象。查阅患者病历，记录年龄、性别、感染部位等一般资料。采用酶联免疫吸附试验试剂盒检测研究对象血清中肿瘤坏死因子 (tumor necrosis factor ，TNF )和 C 反应蛋白(C reactive protein，CP)的浓度。计算序贯性器官衰竭评分(sequential organ failurescore，SOFA)和急性生理学与慢性健康状况评分(acute physiology and chronic health score，APACHE)。观察或随访脓毒症患者的 28 d 预后情况，分为生存组和死亡组。应用逆转录聚合酶链反应测定外周血单核
3、细胞中 mi 147b 的表达水平。结果脓毒症组和普通感染组的年龄、性别、感染部位分布比较差异无统计学意义(P 0.05)。脓毒症组患者的 TNF 、CP 水平、SOFA 评分和 APACHE评分显著高于普通感染组患者(P 0.05)。脓毒症组的外周血单核细胞 mi 147b 的表达水平为6.54 0.93，显著高于普通感染组的表达水平(4.10 0.65)(P 0.05)。脓毒症患者外周血单核细胞 mi 147b 表达水平与 CP 水平、APACHE评分呈显著正相关(r=0.402、0.448，P=0.006、0.004)。28 d 内，脓毒症患者中共 17 例(36.96%)死亡，29例(
4、63.04%)存活。死亡组患者的年龄、TNF 水平、SOFA 评分和 APACHE评分显著高于生存组(P 0.05)。死亡组的外周血单核细胞 mi 147b 表达水平为 7.35 1.12，显著高于存活组的表达水平(6.06 0.83)(P 0.05)。多因素 logistic 回归分析结果显示，外周血单核细胞 mi 147b 表达水平及 APACHE评分是脓毒症患者死亡的独立危险因素(P 0.05)。OC 曲线结果显示外周血单核细胞 mi 147b 表达水平预测患者 28 d 内死亡的曲线下面积为 0.890，95%置信区间为 0.800 0.981(P 0.001)，截断值为 6.86，敏
5、感度和特异度分别为 76.5%和 86.2%。结论脓毒症患者外周血单核细胞 mi 147b 表达水平显著升高，与血清 CP 水平及 APACHE评分有关，并且可作为患者预后的预测标志物。【关键词】脓毒症;mi 147b;急性生理学与慢性健康状况评分;预后【中图分类号】631+2;Q522+2【文献标志码】ADOI:10 13820/j cnki gdyx 20222160Expression of mi 147b in peripheral blood mononuclear cells of patients with sepsis and its correlations withdise
6、ase severity and prognosisHU Hao，ZHANG Sheng li，SHAO MinDepartment of Critical Medicine，theFirst Affiliated Hospital of Anhui Medical University，Hefei 230022，Anhui，ChinaCorresponding author:SHAO Min E mail:shaominmail yahoo com【Abstract】ObjectiveTo investigate the expression level of mi 147b in peri
7、pheral blood mononuclear cells ofpatients with sepsis and its correlations with disease severity and prognosis MethodsForty six patients with sepsis(sepsis group)and 50 patients with common infection(common infection group)who visited the First Affiliated Hospitalof Anhui Medical University from Jan
8、uary 2019 to June 2021 were selected The medical records and general informationsuch as age，gender，and site of infection were recorded for analysis Enzyme linked immunosorbent assay kits were usedto detect the concentrations of tumor necrosis factor (TNF )and C reactive protein(CP)in the serum Se-qu
9、ential Organ Failure Score(SOFA)and Acute Physiology and Chronic Health Score (APACHE)were calculat-ed The 28 day prognosis of sepsis patients was observed or followed up，and they were divided into survival group ordeath group The expression level of mi 147b in peripheral blood mononuclear cells was
10、 determined by reverse tran-scription polymerase chain reaction esultsThere was no significant difference in age，gender，or infection site distri-281广东医学2023 年 2 月 第 44 卷第 2 期Guangdong Medical JournalFeb 2023，Vol 44，No 2网络首发时间：2023-03-02 09:38:45网络首发地址：https:/ between the sepsis group and the common
11、infection group(P 0.05)The TNF ，CP，SOFA and APACHE in the sepsis group were significantly higher than those in the common infection group(P 0.05)The expression lev-el of mi 147b in peripheral blood mononuclear cells of the sepsis group was 6.54 0.93，which was significantly higherthan that of the com
12、mon infection group(4.10 0.65，P 0.05)The expression level of mi 147b in peripheralblood mononuclear cells of patients with sepsis was significantly positively correlated with CP level and APACHE score(r=0.402，0.448;P=0.006，0.004，respectively)Within 28 days，17(36.96%)of sepsis patients died and 29(63
13、 04%)survived Age，TNF level，SOFA score and APACHE score in death group were significantly higherthan those in survival group(P 0.05)The expression level of mi 147b in peripheral blood mononuclear cells of thedeath group was 7 35 1 12，which was significantly higher than that of the survival group(6.0
14、6 0.83)(P 0.05)Multivariate logistic regression analysis showed that the expression level of mi 147b and APACHE score in peripher-al blood monocytes were independent risk factors for death of sepsis patients(P 0.05)The OC curve results showedthat the area under the curve of the expression level of m
15、i 147b in peripheral blood mononuclear cells for predicting thedeath of patients within 28 days was 0.890，and the 95%confidence interval was 0.800 0.981(P 0.001);as thecut off value was 6.86，the sensitivity and specificity were 76.5%and 86.2%，respectively ConclusionThe expres-sion level of mi 147b i
16、n peripheral blood mononuclear cells of patients with sepsis is significantly increased，which iscorrelated to serum CP level and APACHE score，and can be used as a predictive marker for the prognosis of pa-tients【Key words】sepsis;mi 147b;acute physiology and chronic health status score;prognosis脓毒症是一种由感染引起的危及生命的器官功能障碍，且序贯性器官衰竭评分(sequential organfailure assessment，SOFA)2 分1。脓毒症可发生在严重创伤、烧伤、多发伤、休克或大手术后，并迅速从菌血症发展到重要器官衰竭，甚至死亡2。脓毒症是对感染免疫反应失调的结果，在脓毒症的初始阶段，活化的单核细胞/巨噬细胞和中性粒细胞释放多种促炎细胞因子，过度炎症反应和继发性免疫抑制常导致多器