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铜绿假单胞菌脓毒症患者程序性细胞死亡受体1/程序性细胞死亡配体1信号通路相关蛋白与短期临床预后的相关性分析

Correlation of programmed cell death receptor 1/programmed cell death ligand 1 signaling pathway related proteins with clinical short-term prognosis in patients with Pseudomonas aeruginosa sepsis

    摘要
  • 摘要:
    目的 探讨程序性细胞死亡受体1/程序性细胞死亡配体1(PD-1/PD-L1)信号通路相关蛋白对铜绿假单胞菌(PA)脓毒症患者短期临床预后的影响。
    方法 选择2021年1月—2023年6月宁夏医科大学总医院收治的122例PA脓毒症患者为研究对象, 均根据脓毒症治疗指南和实际病情开展治疗。收集患者临床资料、治疗前慢性健康状况评分系统Ⅱ(APACHE Ⅱ) 评分; 治疗前抽取外周静脉血测定T淋巴细胞水平(CD3+、CD4+、CD8+)以及血清PD-1和PD-L1水平。
    结果 122例PA脓毒症患者入住急诊重症监护室及其他科室后28 d存活101例(82.79%, 存活组), 死亡21例(17.21%, 死亡组)。存活组与死亡组患者高血压比率、慢性阻塞性肺病比率、慢性肝病比率、APACHE Ⅱ评分、CD4+、CD4+/CD8+、PD-1和PDL-1比较, 差异有统计学意义(P＜0.05)。单因素Logistic回归分析结果显示，基础疾病(高血压、慢性阻塞性肺病、慢性肝病)、APACHE Ⅱ评分、CD4+/CD8+、PD-1和PD-L1均是PA脓毒症患者短期生存的影响因素(P＜0.01)。多因素Logistic回归分析结果显示, 基础疾病(高血压、慢性阻塞性肺病、慢性肝病)、APACHE Ⅱ评分、PD-1和PD-L1均是PA脓毒症患者短期生存的影响因素(P＜0.01)。
    结论 PD-1/PD-L1信号通路对PA脓毒症患者的临床预后有影响，该通路相关蛋白表达上调可增加PA脓毒症患者短期临床预后不良的风险。

     

    Abstract:
    Objective To investigate the effect of programmed cell death receptor 1/programmed cell death ligand 1 (PD-1/PD-L1) signal pathway associated protein on the short-term clinical prognosis in patients with Pseudomonas aeruginosa (PA) sepsis.
    Methods A total of 122 patients with PA sepsis in the General Hospital of Ningxia Medical University from January 2021 to June 2023 were selected as the research objects, and all the patients were treated according to the therapeutic guideline of sepsis and the actual condition of disease. Clinical data and the score of the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) were collected; the levels of T lymphocytes (CD3+, CD4+ and CD8+) and the levels of serum PD-1 and PD-L1 in peripheral venous blood were determined before treatment.
    Results Of the 122 PA sepsis patients, 101 cases (82.79%, survival group) survived for 28 days after being admitted to the Emergency Intensive Care Unit or other departments, while 21 cases (17.21%, death group) died. There were significant differences in the ratios of hypertension, chronic obstructive pulmonary disease and chronic liver disease, the APACHE Ⅱ scores, and levels of CD4+, CD4+/CD8+, PD-1 and PDL-1 between the survival group and the death group (P < 0.05). Univariate Logistic regression analysis showed that basic diseases (hypertension, chronic obstructive pulmonary disease, chronic liver disease), the APACHE Ⅱ score, CD4+/CD8+, PD-1 and PD-L1 were all factors influencing the short-term survival of PA sepsis patients (P < 0.01). Multivariate Logistic regression analysis indicated that basic diseases (hypertension, chronic obstructive pulmonary disease, chronic liver disease), the APACHE Ⅱ score, PD-1 and PD-L1 were all significant factors affecting the short-term survival of PA sepsis patients (P < 0.01).
    Conclusion The PD-1/PD-L1 signaling pathway has an impact on the clinical prognosis of PA sepsis patients, and up-regulation of this pathway expression can increase the risk of adverse short-term clinical prognosis in PA sepsis patients.

     

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