脓毒症患者血清生存素和沉默信息调节因子2 相关酶1 水平与其他血清炎症因子以及预后的关系研究

目的 研究脓毒症患者血清生存素（survivin）、沉默信息调节因子2 相关酶1（silent mating-type informationregulation 2 homologue 1，SIRT1）水平与其他血清炎症因子以及预后的关系。方法 纳入2018 年9 月～ 2021 年2 月东部战区总医院收治的脓毒症患者130 例（脓毒症组），另选取同期体检的健康志愿者65 例（对照组）。比较两组血清survivin，SIRT1，白细胞介素-1β（interleukin-1β，IL-1β）、白细胞介素-6（interleukin 6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、C 反应蛋白（C-reactive protein ，CRP）和降钙素原（procalcitonin ，PCT）水平。根据住院期间预后分为生存组（n=92）、死亡组（n=38），分析血清survivin 和SIRT1 与炎症因子及急性生理和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ）、序贯器官功能衰竭（sequentialorgan failure assessment ，SOFA）评分的相关性，绘制受试者工作特征曲线（receiver operating characteristic curve ，ROC）分析血清survivin 和SIRT1 评估预后的曲线下面积（area under the curve ，AUC）。结果 脓毒症组血清survivin（423.04±98.65pg/ml） 和SIRT1（0.59±0.11ng/ml） 水平低于对照组（876.43±124.71 pg/ml,1.95±0.43ng/ml）， 血清IL-1β（13.55±3.21pg/ml），IL-6（71.56±18.67 pg/ml），TNF-α（121.18±23.75 pg/ml），CRP（19.23±2.36mg/dl）和PCT（6.72±1.29ng/ml）水平高于对照组（3.41±0.86pg/ml, 5.32±1.22 pg/ml, 5.93±1.18 pg/ml，4.25±0.99 mg/dl，2.31±0.25 ng/ml），差异均有统计学意义（t=25.092 ～ 62.243，均P =0.000）。脓毒症患者生存组血清survivin（435.66±49.75pg/ml）和SIRT1（0.63±0.12ng/ml）水平高于死亡组（392.47±53.35 pg/ml, 10.48±0.10ng/ml），而血清IL-1β（12.14±2.10pg/ml），IL-6（69.63±10.07 pg/ml），TNF-α（116.20±9.13 pg/ml），CRP（18.69±1.82 mg/dl）和PCT（6.33±0.68 ng/ml）水平及APACHEⅡ（13.25±2.64 分）和SOFA评分（5.42±1.20 分）低于死亡组（16.98±1.02pg/ml，76.23±7.64pg/ml，133.23±8.95pg/ml，20.54±1.05mg/dl，7.65±0.36ng/ml，15.88±2.69 分，6.77±1.16 分），差异均有统计学意义（t=3.629 ～ 17.636，均P=0.000）。Pearson 线性相关分析显示血清survivin 和SIRT1 与血清IL-1β，IL-6，TNF-α，CRP 和PCT 水平及APACHE Ⅱ，SOFA 评分呈负相关（r =-0.584 ～ -0.347，均P ＜ 0.05）。血清survivin 和SIRT1 单独与联合评估脓毒症患者预后的AUC（0.95CI）分别为0.710（0.95CI 0.466 ～ 0.957），0.756（0.95CI0.540 ～ 0.965）和0.833（0.95CI 0.740 ～ 0.927）。结论 脓毒症患者血清survivin 和SIRT1 水平降低，二者与促炎因子呈负相关，有望成为预测预后的指标。

Relationship between Serum Survivin and Silent Mating-type Information Regulation 2 Homologue 1 Levels and Other Serum Inflammatory Factors and Prognosis in Patients with Sepsis

Objective To study the relationship between serum survivin (survivin), silent mating type information regulation 2 homologue 1 (SIRT1) levels and other serum inflammatory factors and prognosis in patients with sepsis. Methods Patients with sepsis (sepsis group, n=130) who were admitted to Eastern Theater General Hospital from September 2018 to February 2021 were included. In addition, healthy volunteers (control group, n=65) were selected. The two groups of serum survivin, SIRT1, interleukin-1β (IL-1β), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin (PCT) levels were compared. According to the prognosis of patients during hospitalization, they were divided into survival group (n=92) and death group (n=38). The correlation between serum survivin, SIRT1, inflammatory factors, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ ), sequential organ failure assessment (SOFA) were analyzed. The receiver operating characteristic curve (ROC) was drawn to analyze the area under the curve (AUC) of serum survivin and SIRT1 to assess the prognosis. Results The levels of serum survivin （423.04±98.65pg/ml）and SIRT1（0.59±0.11ng/ml） in the sepsis group were lower than those in the control group（876.43±124.71 pg/ml,1.95±0.43ng/ml），and the levels of serum IL-1β（13.55±3.21pg/ ml），IL-6（71.56±18.67 pg/ml）, TNF-α（121.18±23.75 pg/ml）, CRP（19.23±2.36mg/dl） and PCT （6.72±1.29ng/ ml）were higher than those in the control group（3.41±0.86pg/ml, 5.32±1.22 pg/ml, 5.93±1.18 pg/ml，4.25±0.99 mg/dl， 2.31±0.25 ng/ml），the differences were statistically significant(t=25.092 ～ 62.243, all P=0.000). The levels of serum survivin （435.66±49.75pg/ml）and SIRT1（0.63±0.12ng/ml） in the survival group of patients with sepsis were higher than those in the death group（392.47±53.35 pg/ml, 10.48±0.10ng/ml）, while the serum levels of IL-1β（12.14±2.10pg/ml ）, IL-6 （69.63±10.07 pg/ml）, TNF-α（116.20±9.13 pg/ml）, CRP（18.69±1.82 mg/dl）, PCT（6.33±0.68 ng/ml） and APACHE Ⅱ（13.25±2.64 point）, SOFA（5.42±1.20 point） scores were lower than those in the death group （16.98±1.02pg/ ml，76.23±7.64pg/ml，133.23±8.95pg/ml，20.54±1.05mg/dl，7.65±0.36ng/ml，15.88±2.69 point， 6.77±1.16 point）, the differences were statistically significant（t=3.629 ～ 17.636，all P=0.000）. Pearson linear correlation analysis showed that serum survivin and SIRT1 were negatively correlated with serum IL-1β, IL-6, TNF-α, CRP, PCT levels and APACHE Ⅱ , SOFA scores (r=-0.584 ～ -0.347, all P ＜ 0.05). The AUC (0.95CI) of serum survivin and SIRT1 alone and in combination to assess the prognosis of patients with sepsis were 0.710 (0.95CI 0.466 ～ 0.957), 0.756 (0.95CI 0.540 ～ 0.965) and 0.833 (0.95CI 0.740 ～ 0.927), respectively. Conclusion The levels of serum survivin and SIRT1 in patients with sepsis were reduced, and the two were negatively correlated with pro inflammatory factors, which are expected to be indicators of prognosis.