HMOX1和MAPK14与脓毒症急性肺损伤患儿发病和预后的关系

doi:10.11958/20251919

摘要/Abstract

摘要：

目的探讨铁死亡相关分子血红素加氧酶-1（HMOX1）和丝裂原活化蛋白激酶14（MAPK14）与脓毒症急性肺损伤（ALI）患儿发病和预后的关系。方法选取102例脓毒症患儿，其中合并ALI组54例，未合并组48例。比较2组临床资料、实验室检查指标、器官功能评分和血清HMOX1和MAPK14水平的差异，并对不同HMOX1和MAPK14水平的患儿进行28 d和90 d的死亡率分析。结果与未合并组相比，合并ALI组患儿的降钙素原（PCT）、乳酸（Lac）、小儿器官功能障碍Logistic-2评分（PELOD-2）、小儿死亡危险评分第3版（PRISMⅢ）和序贯器官衰竭（SOFA）评分、血清HMOX1和MAPK14水平均升高（P<0.05）。HMOX1和MAPK14对脓毒症患者发生ALI具有良好的预测价值，受试者工作特征曲线下面积分别为0.872（95%CI：0.791~0.930）和0.825（95%CI：0.737~0.893），最佳临界值分别为3.1 μg/L和3.8 μg/L。根据HMOX1和MAPK14的临界值分组后，不同水平HMOX1和MAPK14患儿的28 d和90 d的死亡率比较差异均无统计学意义（P>0.05）。结论脓毒症ALI患儿早期血清HMOX1和MAPK14表达升高，可能是ALI发病的生物标志物，但对患儿的预后无明显影响。

关键词: 脓毒症, 急性肺损伤, 铁死亡, 血红素加氧酶-1, 丝裂原活化蛋白激酶14, 预后, 儿童

Abstract:

Objective To explore the relationship between the ferroptosis-related molecules heme oxygenase-1 (HMOX1) and mitogen-activated protein kinase 14 (MAPK14) with the onset and prognosis of acute lung injury (ALI) in children with sepsis. Methods A total of 102 children with sepsis were selected, including 54 in the ALI group and 48 in the non-ALI group. Clinical data, laboratory tests, organ function scores and serum levels of HMOX1 and MAPK14 were compared between the two groups. The mortality rates of children with different levels of HMOX1 and MAPK14 at 28-day and 90-day were analyzed. Results Compared with the non-ALI group, procalcitonin (PCT), lactate (Lac), pediatric organ dysfunction Logistic-2 score (PELOD-2), pediatric risk of mortality score version 3 (PRISM III) and sequential organ failure assessment (SOFA) scores were increased in the ALI group (P<0.05). Serum levels of HMOX1 and MAPK14 were significantly higher in the ALI group than those in the non-ALI group (P<0.05). HMOX1 and MAPK14 showed good predictive value for the occurrence of ALI in sepsis patients, with AUC values of 0.872 (95%CI: 0.791-0.930) and 0.825 (95%CI:0.737-0.893), and the optimal cutoff values were 3.1 μg/L and 3.8 μg/L, respectively. After grouping by the cutoff values of HMOX1 and MAPK14, there were no significant differences in the 28-day and 90-day mortality rates in children with different levels of HMOX1 and MAPK14 (P>0.05). Conclusion The expression levels of serum HMOX1 and MAPK14 increase in the early stage of sepsis-related ALI, which may serve as biomarkers for the onset of ALI, and they have no significant impact on the prognosis of children.

Key words: sepsis, acute lung injury, ferroptosis, heme oxygenase-1, mitogen-activated protein kinase 14, prognosis, child

中图分类号:

R726.31

图/表 7

表1 合并ALI组和未合并组临床和实验室检查结果比较

Tab. 1 Comparison of clinical and laboratory examination results between the two groups of patients

组别		n	年龄/岁		男性		BMI/（kg/m²）
未合并组		48	7.9±4.0		23（47.9）		19.3.±3.2
合并ALI组		54	8.3±3.5		29（53.7）		20.1±4.1
t或χ²			0.539		0.341		1.089
组别		PCT/（μg/L）			CRP/（mg/L）		Lac/（mmol/L）		AST/（U/L）
未合并组		1.8±1.2			47.0±23.2		3.5±0.9		34.2±9.5
合并ALI组		2.5±1.5			52.7±24.1		4.2±1.8		35.8±9.7
t		2.581^＊			1.213		8.634^＊＊		0.840
组别	ALT/（U/L）			Tbil/（μmol/L）		SCr/（μmol/L）		BUN/（mmol/L）
未合并组	39.8±11.6			1.13±0.28		87.5±15.9		5.9±1.4
合并ALI组	42.7±12.3			1.14±0.32		92.8±23.9		6.2±1.3
t	1.221			0.167		1.303		1.122

表2 合并ALI组和未合并组PELOD-2评分、PRISM Ⅲ评分、SOFA评分比较（分，$\bar{x}±s$）

Tab.2 Comparison of PELOD-2 score, PRISM Ⅲ score and SOFA score between the two groups of patients

组别	n	PELOD-2评分	PRISMⅢ评分	SOFA评分
未合并组	48	13.2±4.1	28.0±7.2	7.1±2.5
合并ALI组	54	15.3±5.2	32.9±8.1	10.8±3.1
t		2.245^＊	3.212^＊＊	6.582^＊＊

表3 合并ALI组和未合并组血清HMOX1和MAPK14比较（$\bar{x}±s$）

Tab.3 Comparison of serum HMOX1 and MAPK14 between the two groups of patients

组别	n	HMOX1/（μg/L）	MAPK14/（μg/L）
未合并组	48	2.71±0.34	3.27±0.43
合并ALI组	54	3.42±0.50	4.04±0.66
t		3.058^＊＊	3.451^＊＊

图1 血清HMOX1和MAPK14蛋白预测脓毒症患者发生ALI的ROC曲线

Fig.1 ROC curve for predicting pulmonary injury in sepsis patients based on serum HMOX1 and MAPK14 protein levels

表4 血清HMOX1和MAPK14蛋白预测脓毒症患者发生ALI的临床价值

Tab.4 The clinical value of serum HMOX1 and MAPK14 proteins in predicting pulmonary injury in patients with sepsis

变量	AUC（95%CI）	最佳临界值	敏感度/ %	特异度/ %	约登指数
HMOX1蛋白	0.872（0.791~0.930）	3.1 μg/L	73.58	89.80	0.633
MAPK14蛋白	0.825（0.737~0.893）	3.8 μg/L	64.15	87.76	0.152

图2 不同HMOX1水平患儿28 d和90 d生存曲线

Fig.2 Survival curves of children with different HMOX1 levels at 28 days and 90 days

图3 不同MAPK14水平患儿28 d和90 d生存曲线

Fig.3 Survival curves of children with different MAPK14 levels at 28 days and 90 days

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