核苷酸结合寡聚化结构域样受体蛋白3炎性小体、炎性因子、半胱氨酸天冬氨酸蛋白酶-1与烧伤合并吸入性损伤预后的相关性分析

目的探讨核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体、炎性因子、半胱氨酸天冬氨酸蛋白酶-1(Caspase-1)与烧伤合并吸入性损伤的预后相关性。 方法回顾性分析2015年3月至2019年12月北海市人民医院烧伤外科收治的47例烧伤合并吸入性损伤患者的临床资料。根据患者住院期间病情恢复情况分为预后良好组(n＝19)和预后不良组(n＝28)。收集2组患者的临床资料，包括患者性别、年龄、烧伤后入院时间、烧伤面积、烧伤深度；采用酶联免疫吸附试验(ELISA)和实时荧光定量聚合酶链反应(qRT-PCR)法分别检测血清中白细胞介素(IL)-1β、IL-6、IL-8、IL-18、肿瘤坏死因子-α(TNF-α)水平及外周血单个核细胞中NLRP3炎性小体mRNA、Caspase-1 mRNA水平。数据行t检验、χ²检验或Fisher确切概率法、多因素Logistic回归分析及Pearson相关性分析。 结果2组患者性别、年龄、烧伤后入院时间、烧伤面积、烧伤深度、IL-6比较，差异均无统计学意义(P值均大于0.05)。预后良好组患者IL-1β、IL-18、NLRP3炎性小体mRNA、Caspase-1 mRNA表达水平分别为(37.28±6.54) pg/mL、(38.26±8.79) pg/mL、1.75±0.35、1.15±0.27，预后不良组患者IL-1β、IL-18、NLRP3炎性小体mRNA、Caspase-1 mRNA表达水平分别为(49.46±8.87) pg/mL、(76.83±10.58) pg/mL、2.23±0.41、1.94±0.36, 2组比较差异均有统计学意义(t＝5.11、13.10、4.17、8.13，P值均小于0.05)；多因素Logistic回归分析显示，IL-1β、IL-18、NLRP3炎性小体mRNA、Caspase-1 mRNA表达水平是导致烧伤合吸入性损伤预后不良的独立危险因素(β＝1.56、0.87、1.05、1.11，P值均小于0.05)。经Pearson相关分析显示，IL-1β、IL-18、NLRP3炎性小体mRNA、Caspase-1 mRNA水平与烧伤合并吸入性损伤预后不良呈正相关(r＝0.42、0.39、0.52、0.56，P值均小于0.05)。 结论IL-1β、IL-18、NLRP3炎性小体、Caspase-1的水平异常升高可作为烧伤合并吸入性损伤患者预后不良的特征指标，可根据上述指标指导临床进行早期救治，有助于降低烧伤合并吸入性损伤患者的病死率。

Correlation analysis of nucleotide-binding oligomerization domain-like receptor protein 3 inflammasome,inflammatory factors,cysteine aspartic acid protease-1 and prognosis of burn combined with inhalation injury

ObjectiveTo explore the relationship between nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome, inflammatory factors, cysteine aspartic acid protease-1 (Caspase-1) and the prognosis of burn combined with inhalation injury. MethodsThe clinical data of 47 burn patients with inhalation injury from March 2015 to December 2019 in Department of Burn Surgery, Beihai People′s Hospital were analyzed retrospectively. The patients were divided into good prognosis group (n=19) and poor prognosis group (n=28) according to the recovery of disease during hospitalization. The clinical data of all patients were collected, including sex, age, hospitalization time after burns, burns area, burns depth. The levels of interleukin (IL)-1β, IL-6, IL-8, IL-18 and tumor necrosis factor-α (TNF-α) in serum were collected. NLRP3 inflammasome mRNA and Caspase-1 mRNA in peripheral blood mononuclear cells were detected by enzyme-linked immunosorbent assay(ELISA) and real-time quantitative polymerase chain reaction (qRT-PCR) respectively. Data were analyzed with t test, chi-square test or Fisher exact probability method, multivariate logistic regression and pearson correlation. ResultsThere were no statistically significant differences in gender, age, hospitalization time, burns area, burns depth and IL-6 between the two groups (with P values above 0.05). The expression levels of IL-1β, IL-18, NLRP3 inflammasome mRNA and Caspase-1 mRNA in good prognosis group were (37.28±6.54) pg/mL, (38.26±8.79) pg/mL, 1.75±0.35 and 1.15±0.27, while those in poor prognosis group were (49.46±8.87) pg/mL, (76.83±10.58) pg/mL, 2.23±0.41 and 1.94±0.36. The differences between the two groups were statistically significant (t=5.11, 13.10, 4.17, 8.13; with P values below 0.05). Multivariate logistic regression analysis showed that the levels of IL-1β, IL-18, NLRP3 inflammasome mRNA and Caspase-1 mRNA were independent risk factors for poor prognosis of burn inhalation injury (β= 1.56, 0.87 1.05, 1.11; with P values below 0.05). Pearson correlation analysis showed that the levels of IL-1β, IL-18, NLRP3 inflammasome mRNA and Caspase-1 mRNA were positively correlated with the poor prognosis of burn inhalation injury (r= 0.42, 0.39, 0.52, 0.56; with P values below 0.05). ConclusionAbnormal elevated levels of IL-1β, IL-18, NLRP3 inflamesome, and Caspase-1 can be used as indicators of poor prognosis in patients with burn inhalation injury, and can guide clinical early treatment according to these indicators, which can help reduce the mortality of patients with burn combined with inhalation injury.