血管紧张素转换酶基因多态性与呼吸ICU脓毒性休克患者病情及预后分析

目的探讨血管紧张素转换酶(ACE)基因多态性与呼吸重症监护室(ICU)脓毒性休克患者病情及预后关联性。方法选择湖州市中心医院呼吸重症监护室2016年6月-2020年3月收治的脓毒性休克患者80例作为研究组,按照1∶1选择同期呼吸ICU收治的脓毒症患者80例作为对照组。所有患者均于入住ICU后抽取外周静脉血,采用聚合酶链式扩增反应(PCR)对模板中目标序列进行扩增,并对分型结果进行鉴定。对血清中ACE水平进行检测。统计研究组患者入住ICU 24 h后急性生理与慢性健康评分(APACHE II)、序贯器官衰竭评分(SOFA)、ICU住院时间及28 d死亡情况。结果研究组ACE基因rs4291位点AA、TT基因型及C、T等位基因频率分别为:23.75%、26.25%、48.75%、51.25%,与对照组相比差异有统计学意义(P<0.05);该位点TT基因型(OR=1.134)及T等位基因(OR=1.316)是脓毒症患者发生脓毒性休克的影响因素(P<0.05);AT型/TT型研究组患者血清ACE水平、APACHE II评分、SOFA评分、ICU住院时间及28 d病死率分别为(6.51±2.12)ng/ml、(31.26±12.41)、(10.39±2.59)、(16.84±4.38)d、40.98%(25/61)高于AA型研究组患者(P<0.05)。结论 ACE基因rs4291位点多态性与本地区人群脓毒性休克易感性有关,其中T等位基因为易感基因,携带该基因患者病情加重及不良预后的风险明显增加。

Angiotensin-converting enzyme gene polymorphism,condition and prognosis of patients with septic shock in respiratory ICU

OBJECTIVE To investigate the relationship between angiotensin-converting enzyme(ACE) gene polymorphism and the condition and prognosis of patients with septic shock in respiratory ICU. METHODS Totally 80 patients with septic shock admitted to the respiratory intensive care unit of Huzhou Central Hospital from Jun. 2016 to Mar. 2020 were selected as the study group, and 80 patients with sepsis admitted to the respiratory ICU during the same period were selected as the control group according to 1∶1. All patients were drawn from peripheral venous blood after admission to the ICU, and the target sequence in the template was amplified by polymerase chain amplification reaction(PCR), and the typing results were identified. The level of ACE in serum were measured. The acute physiology and chronic health score(APACHE II), the sequential organ failure score(SOFA), the length of stay in the ICU and the 28-day death of the patients in the study group 24 hours after entering the ICU were analyzed. RESULTS The frequencies of AA, TT genotypes and C/T alleles at the rs4291 locus of the ACE gene in the study group were: 23.75%, 26.25%, 48.75%, and 51.25%, respectively, which was significant compared with the control group(P<0.05);the TT genotype(OR=1.134) and T allele(OR=1.316) of this locus were the influencing factors of septic shock in patients with sepsis(P<0.05);serum ACE level, APACHE II score, SOFA score, ICU hospital stay and 28-day mortality rate of patients in AT/TT study group were(6.51±2.12) ng/ml,(31.26±12.41),(10.39±2.59),(16.84±4.38)d, and 40.98%(25/61), respectively, significantly higher than that of patients in the AA study group(P<0.05). CONCLUSION The rs4291 polymorphism of the ACE gene was related to the susceptibility of the population with septic shock in this region, among which the T allele was a susceptible gene, and patients with this gene were at increased risk of aggravation and poor prognosis.