血清焦亡蛋白对脓毒症急性肝损伤病情及预后的评估价值

摘要/Abstract

摘要： 目的研究血清焦亡蛋白对脓毒症急性肝损伤病情及预后的评估价值。方法选择2019年5月—2022年4月期间河西学院附属张掖人民医院收治的脓毒症患者作为研究对象,参照急性肝损伤的诊断标准分为急性肝损伤组和无肝损伤组。入院时采集患者血清并检测焦亡蛋白含半胱氨酸的天冬氨酸蛋白水解酶-1(Caspase-1)及Gasdermin-D(GSDMD)的含量;评价脓毒症合并急性肝损伤的类型,分为高胆红素型、高转氨酶型、高胆红素高转氨酶型;评价脓毒症合并急性肝损伤的预后,分为死亡和存活。结果急性肝损伤组患者的血清Caspase-1、GSDMD含量分别为(1446.40±351.11)pg/mL、(8.21±2.04)ng/mL,均高于无肝损伤组的(1021.35±288.32)pg/mL、(6.59±1.57)ng/mL(P<0.05);急性肝损伤组患者的血清Caspase-1、GSDMD含量与C反应蛋白、降钙素原、急性生理学与慢性健康状况评分II(APACHE II)、序贯器官衰竭评分(SOFA)呈正相关;急性肝损伤组中高胆红素高转氨酶型患者的血清Caspase-1、GSDMD含量分别为(1906.02±332.32)pg/mL、(9.94±1.97)ng/mL,高于高转氨酶型患者的(1333.77±267.70)pg/mL、(7.74±1.28)ng/mL和高胆红素型患者的(1318.12±270.93)pg/mL、(7.54±2.04)ng/mL;死亡患者的血清Caspase-1、GSDMD含量分别为(1685.37±328.10)pg/mL、(9.76±1.61)ng/mL,高于存活患者的(1275.70±256.33)pg/mL、(7.10±1.53)ng/mL(P<0.05);血清Caspase-1、GSDMD含量对脓毒症合并急性肝损伤患者的高胆红素高转氨酶型具有诊断价值、对死亡具有预测价值。结论脓毒症合并急性肝损伤患者的血清焦亡蛋白Caspase-1、GSDMD含量增加,血清Caspase-1、GSDMD对病情及预后具有评估价值。

关键词: 脓毒症, 急性肝损伤, 焦亡, 含半胱氨酸的天冬氨酸蛋白水解酶-1, Gasdermin-D, 预后

Abstract: Objective To investigate the diagnostic and prognostic significance of serum pyroprotein in assessing the severity and outcome of acute liver injury in sepsis patients. Methods Patients with sepsis admitted to our hospital from May 2019 to April 2022 were enrolled as research subjects and divided into acute liver injury group and non-liver injury groups, according to the diagnostic criteria for acute liver injury. Upon admission, serum samples were collected from the patients to measure leves of pyroprotein, Caspase-1 and Gastermin-D (GSDMD). The research further classified the types of sepsis accompanied by acute liver injury into three categories: high bilirubin type, high transaminase type, and combined high bilirubin and high transaminase type. Additionally, the prognosis of sepsis patients with acute liver injury was evaluated in terms of survival and mortality outcomes. Results In patients with acute liver injury, serum Caspase-1 and GSDMD levels were significantly elevated, measuring(1446.40±351.11) pg/mL and (8.21±2.04) ng/mL respectively, compared to (1021.35±288.32) pg/mL and (6.59±1.57) ng/mL in patients without liver injury (P<0.05). These levels showed a positive correlation with C-reactive protein, procalcitonin, APACHE II and SOFA scores in acute liver injury cases. Notably, in the subset of patients exhibiting both high bilirubin and high transaminase levels, Caspase-1 and GSDMD were found at (1906.02±332.32) pg/mL and (9.94±1.97) ng/mL, respectively. These levels were higher than those in patients with only high transaminase (1333.77±267.70 pg/mL, 7.74±1.28 ng/mL) and those with only high bilirubin (1318.12±270.93 pg/mL, 7.54±2.04 ng/mL) within the acute liver injury group, Furthermore, the serum levels of Caspase-1 and GSDMD in patients who succumbed to their condition were (1685.37±328.10) pg/mL, (9.76±1.61) ng/mL, respectively, significantly higher than those who survived, who presented with levels of (1275.70±256.33) pg/mL, (7.10±1.53) ng/mL(P<0.05). This indicates that serum Caspase-1 and GSDMD levels had diagnostic relevance for identifying high bilirubin and high transaminase types, as well as prognostic value in predicting mortality among sepsis patients with acute liver injury. Conclusion The serum levels of Caspase-1 and GSDMD are elevated in sepsis patients with acute liver injury, indicating their significant value in assessing the severity and predicting the prognosis of the condition.

Key words: Sepsis, Acute liver injury, Pyroptosis, Caspase-1, Gasdermin-D, Prognosis

尚德民, 何通. 血清焦亡蛋白对脓毒症急性肝损伤病情及预后的评估价值[J]. 肝脏, 2024, 29(2): 215-219.

SHANG De-min, HE Tong. The prognostic and diagnostic value of serum pyroprotein levels in assessing the severity of acute liver injury in sepsis patients[J]. Chinese Hepatolgy, 2024, 29(2): 215-219.

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