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中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 296 -300. doi: 10.3877/cma.j.issn.1674-1358.2020.04.006

所属专题： 文献；

论著

颅脑损伤术后感染者调节细胞凋亡线粒体蛋白和星形胶质源性蛋白表达水平
郑永1,†(), 周蕾2, 郭宗培3   
  1. 1. 100039　北京，解放军总医院第三医学中心
    2. 100039　北京，北京市西城区广外社区卫生服务中心
    3. 100039　北京，北京市红十字会急诊抢救中心神经外科
  • 收稿日期:2019-10-22 出版日期:2020-08-15
  • 通信作者: 郑永

Expression of apoptosis-induced mitochondrial protein and astrocyte-derived protein of patients with infection after craniocerebral injury

Yong Zheng1,†(), Lei Zhou2, Zongpei Guo3   

  1. 1. The Third Medical Center of the PLA General Hospital, Beijing 100039, China
    2. Guangwai Community Health Service Center, Xicheng District, Beijing 100039, China
    3. Department of Neurosurgery, Beijing Red Cross Emergency Rescue Center, Beijing 100039, China
  • Received:2019-10-22 Published:2020-08-15
  • Corresponding author: Yong Zheng
  • About author:
    Corresponding author: Zheng Yong, Email:
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引用本文：

郑永, 周蕾, 郭宗培. 颅脑损伤术后感染者调节细胞凋亡线粒体蛋白和星形胶质源性蛋白表达水平[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(04): 296-300.

Yong Zheng, Lei Zhou, Zongpei Guo. Expression of apoptosis-induced mitochondrial protein and astrocyte-derived protein of patients with infection after craniocerebral injury[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(04): 296-300.

目的

探讨颅脑损伤术后感染者调节细胞凋亡线粒体蛋白（Smac）和星形胶质源性蛋白（S100B）水平，并分析其与疗效及预后的关系。

方法

选取2016年1月至2018年1月解放军总医院第三医学中心收治的112例颅脑损伤术后感染者（术后感染组）、50例颅脑损伤术后未感染者（未感染组）和50例健康体检者（对照组）作为研究对象。采用酶联免疫吸附试验检测各组研究对象血清Smac和S100B蛋白水平。绘制受试工作者曲线（ROC）分析血清Smac和S100B对颅脑损伤术后感染的诊断价值；采用Logistic回归分析血清Smac和S100B蛋白对颅脑术后感染者预后的影响。

结果

术后感染组、未感染组和对照组研究对象血清Smac和S100B水平比较，差异均有统计学意义（F = 11.346、 P = 0.001，F = 9.524、P = 0.008），其中术后感染组患者低于未感染组（Smac：t = 5.836、P < 0.001，S100B：t = 7.782、P < 0.001），未感染组患者低于对照组（Smac：t = 2.946、P = 0.004，S100B：t = 3.889、P < 0.001）。血清Smac和S100B单项检测对颅脑损伤术后感染有一定诊断价值（Smac：AUC = 0.689，95%CI：0.624～0.757，P = 0.023；S100B：AUC = 0.718，95%CI：0.653～0.749，P = 0.011），两者联合检测则可提高其诊断效能（AUC = 0.857，95%CI：0.811～0.926，P = 0.005）。与治疗前比较，术后感染组患者治疗后血清Smac和S100B蛋白水平显著升高，差异有统计学意义（t = 4.802、6.499，P均< 0.001）。随访6个月，死亡患者、预后不良患者和预后良好患者血清Smac和S100B水平差异有统计学意义（F = 15.065、P < 0.001，F = 7.194、P = 0.016），其中死亡患者水平显著低于预后不良者（t = 2.06、P = 0.046，t = 2.297、P = 0.028），预后不良患者水平显著低于预后良好者（t = 4.225、7.110，P < 0.001），差异均有统计学意义。经Logistic回归分析，治疗前血清Smac和S100B蛋白是颅脑术后感染者预后的保护性因素（P = 0.008、0.003）。

结论

血清Smac和S100B蛋白水平在颅脑损伤术后感染者中低表达，对颅脑损伤术后病原菌感染有一定诊断价值，两者联合可显著提高其诊断效能，并影响疗效及预后。

关键词: 颅脑损伤, 术后感染, 细胞凋亡线粒体蛋白, 星形胶质源性蛋白, 疗效, 预后
Objective

To investigate levels of mitochondrial protein (Smac) and astrocyte-derived protein (S100B) regulated by pathogen infection after craniocerebral injury, and to analyze their relationship with curative effect and prognosis.

Methods

From January 2016 to January 2018, a total of 112 cases with infection after brain injury surgery (postoperative infection group), 50 cases without infection after brain injury surgery (uninfected group) and 50 cases of healthy examination (control group) in the Third Medical Center of the PLA General Hospital were selected. The levels of serum Smac and S100B protein were detected by enzyme linked immunosorbent assay. The diagnostic values of serum Smac and S100B on postoperative infection after brain injury surgery were analyzed by receiver operating characteristic curve (ROC). The effect of serum Smac and S100B protein on the prognosis of patients with infection after brain injury surgery was analyzed by Logistic regression analysis.

Results

The levels of serum Smac and S100B of cases in postoperative infection group, uninfected group and control group were significantly different (F = 11.346, P = 0.001; F = 9.524, P = 0.008), among whom, patients in postoperative infection group were significantly lower than those of uninfected group (Smac: t = 5.836, P < 0.001; S100B: t = 7.782, P < 0.001), patients in uninfected group were significantly lower than those of control group (Smac: t = 2.946, P = 0.004; S100B: t = 3.889, P < 0.001). Single test of serum Smac or S100B had certain diagnostic value for infection after brain injury surgery (Smac: AUC = 0.689, 95%CI: 0.624-0.757, P = 0.023; S100B: AUC = 0.718, 95%CI: 0.653-0.749, P = 0.011), and the combination of the two indexes could improve the diagnostic efficacy (AUC = 0.857, 95%CI: 0.811-0.926, P = 0.005). Compared with before treatment, the levels of serum Smac and S100B protein were significantly higher of cases in postoperative infection group after treatment, with significant differences (t = 4.802, 6.499; both P < 0.001). There were significant differences in serum Smac and S100B levels of patients with death, poor prognosis and good prognosis after 6 months follow-up (F = 15.065, P < 0.001; F = 7.194, P = 0.016), among whom, Smac and S100B levels of patients with death were significantly lower than those of cases with poor prognosis (t = 2.06, P = 0.046; t = 2.297, P = 0.028); Smac and S100B levels of patients with poor prognosis were significantly lower than those of cases with good prognosis (t = 4.225, 7.110; P < 0.001), all with significant differences. Logistic regression analysis showed that serum Smac and S100B protein were protective factors for the prognosis of infection after brain injury surgery (P = 0.008, 0.003).

Conclusions

The levels of serum Smac and S100B protein were lowly expressed in patients with infection after brain injury surgery, which had certain diagnostic value on pathogen infection. The combination of the two indexes could significantly improve the diagnostic efficacy and affect the curative effect and prognosis.

Key words: Craniocerebral injury, Postoperative infection, Apoptosis mitochondrial protein, Astrocyte-derived protein, Efficacy, Prognosis
表2 三组血清Smac和S100B水平（ ± s，μg/ml）
组别 例数 Smac S100B
术后感染组 112 0.42 ± 0.08 0.21 ± 0.06
未感染组 50 0.53 ± 0.16 0.32 ± 0.12
对照组 50 0.64 ± 0.21 0.43 ± 0.16
F值 ? 11.346 9.524
P值 ? 0.001 0.008
图1 血清Smac和S100B单项及联合检测对颅脑损伤术后感染的诊断ROC曲线
表3 血清Smac和S100B对颅脑损伤术后感染的诊断价值
指标 AUC 95%CI P值 截断值 特异性（%） 敏感度（%）
Smac 0.689 0.624～0.757 0.023 0.42 62.3 67.8
S100B 0.718 0.653～0.749 0.011 0.24 64.1 69.9
Smac + S100B 0.857 0.811～0.926 0.005 0.44 + 0.27 79.6 82.4
表4 颅脑损伤术后感染者治疗前后血清Smac和S100B（ ± s，μg/ml）
组别 例数 Smac S100B
治疗前 112 0.42 ± 0.08 0.21 ± 0.06
治疗后 112 0.56 ± 0.19 0.35 ± 0.14
t值 ? 4.802 6.499
P值 ? < 0.001 < 0.001
表1 三组研究对象的一般资料
组别 例数 男/女（例） 年龄（ ± s，岁）
术后感染组 112 68/44 46.27 ± 8.73
未感染组 50 32/18 46.63 ± 8.41
对照组 50 30/20 47.04 ± 8.81
统计量 ? χ2 = 0.206 F = 1.126
P值 ? 0.902 0.883
表5 颅脑损伤术后感染者不同预后组治疗前后血清Smac和S100B（ ± s，μg/ml）
组别 例数 Smac t值 P值 S100B t值 P值
治疗前 治疗后 ? ? 治疗前 治疗后 ? ?
死亡组 6 0.31 ± 0.12 0.41 ± 0.10 4.294 0.027 0.10 ± 0.05 0.23 ± 0.05 4.503 0.001
不良预后组 32 0.38 ± 0.06 0.51 ± 0.11 5.869 < 0.001 0.19 ± 0.09 0.29 ± 0.06 5.230 < 0.001
良好预后组 74 0.45 ± 0.04 0.58 ± 0.06 10.198 < 0.001 0.25 ± 0.02 0.37 ± 0.05 12.605 < 0.001
F值 ? 9.157 15.065 ? ? 6.152 7.194 ? ?
P值 ? 0.009 < 0.001 ? ? 0.027 0.016 ? ?
表6 血清Smac和S100B蛋白对颅脑术后感染者预后的影响
指标 β值 SE值 Wald χ2值 P值 OR值 95%CI
血清Smac 0.904 0.113 7.126 0.008 0.438 0.371～0.604
血清S100B 1.251 0.267 8.934 0.003 0.513 0.392～0.672
[1]
甘宁, 刘思思, 李英姿, 等. 重型颅脑损伤患者改良大骨瓣减压术中渐进减压与常规减压对比观察[J]. 山东医药,2017,57(27):70-72.
[2]
陈晨, 赵龙详, 陈旭仁, 等. 颅脑损伤手术中急性脑膨出的形成原因初步探讨[J]. 国际神经病学神经外科学杂志,2017,44(1):20-23.
[3]
李瑞. 颅脑损伤手术患者医院感染危险因素分析及对策[J]. 西南国防医药,2017,27(7):726-728.
[4]
王昆鹏, 王维兴, 杨婕, 等. 国内颅脑损伤术后颅内感染危险因素的Meta分析[J].河北医学,2018,24(9):1527-1532.
[5]
Ali R, Singh S, Haq W. IAP proteins antagonist: an introduction and chemistry of smac mimetics under clinical development[J]. Curr Med Chem,2018,25(31):3768-3795.
[6]
Boddu P, Carter BZ, Verstovsek S, et al. SMAC mimetics as potential cancer therapeutics in myeloid malignancies[J]. Br J Haematol,2019,185(2):219-231.
[7]
杨钟灵, 雷鹏, 刘宗宝. 大鼠脑损伤后XIAP与Smac/DIABLO表达的实验研究[J]. 西北国防医学杂志,2009,30(5):331-333.
[8]
Wu L, Zhou X, Xiao Z, et al. Functional expression, characterization, and application of human S100B[J]. Oncol Rep,2017,38(4):2309-2316.
[9]
Thelin EP, Nelson DW, Bellander BM. A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury[J]. Acta Neurochir (Wien),2017,159(2):209-225.
[10]
Dowarha D, Chou RH, Yu C. S100B as an antagonist to interfere with the interface area flanked by S100A11 and RAGE V domain[J]. ACS Omega,2018,3(8):9689-9698.
[11]
杜晓光, 董保忠, 李琛, 等. ICU重型颅脑损伤患者肺部感染的影响因素与抗菌药物使用情况研究[J]. 中华医院感染学杂志,2017,27(22):5145-5148.
[12]
黄从刚, 段发亮, 吴京雷, 等. 颅脑损伤患者Homer1a蛋白表达及其与神经元损伤,凋亡的关系研究[J]. 中华神经医学杂志,2017,16(6):595-598.
[13]
马锦华, 高静, 王珊珊, 等. 西安市2025例颅脑损伤住院患者临床及流行病学特点[J]. 创伤外科杂志,2017,19(6):411-416.
[14]
McMillan T, Wilson L, Ponsford J, et al. The glasgow outcome scale-40 years of application and refinement[J]. Nat Rev Neurol,2016,12(8):477-485.
[15]
李泉文, 洪兴国, 陈山林. 创伤性颅脑损伤患者预后相关影响因素分析[J]. 国际外科学杂志,2018,45(10):684-687.
[16]
武晓灵, 喻莉, 龙鼎. suPAR及D-二聚体对创伤性颅脑损伤患者病情严重程度及预后的判断价值[J]. 实用医学杂志,2017,33(2):234-237.
[17]
张超, 高国一, 冯军峰, 等. 脑脊液压力相关参数预判颅脑损伤后脑积水分流术疗效的研究[J]. 中华神经外科杂志,2019,35(2):115-119.
[18]
焦曦, 赵冬, 何学君, 等. 钙敏感受体在创伤性颅脑损伤大鼠神经元凋亡中的作用[J]. 中华神经外科杂志,2018,34(2):200-205.
[19]
陈方慧, 王弋, 董晓巧, 等. 线粒体Omi/HtrA2信号通路在颅脑损伤后神经细胞凋亡中的作用[J/CD]. 中华危重症医学杂志(电子版),2018,11(2):104-109.
[20]
李帅, 张炳东. 细胞凋亡途径的研究进展[J]. 山东医药,2017,57(37): 109-112.
[21]
王可. 哈巴苷对急性脑缺血及线粒体介导的Caspase依赖性细胞凋亡信号通路的影响[J]. 中国药理学通报,2017,33(4):563-567.
[22]
刘一民, 赵艳艳, 陈红兵. 神经干细胞移植脑缺血模型大鼠神经细胞凋亡,分化及神经行为学的变化[J]. 中国组织工程研究,2017,21(13):2029-2035.
[23]
Du C, Fang M, Li Y, et al. Smac, a mitochondrial protein that promotes cytochrome c-dependent caspase activation by eliminating IAP inhibition[J]. Cell,2000,102(1):33-42.
[24]
Wu L, Zhou X, Xiao Z, et al. Functional expression, characterization, and application of human S100B[J]. Oncol Rep,2017,38(4):2309-2316.
[25]
Thelin EP, Nelson DW, Bellander BM. A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury[J]. Acta Neurochir (Wien),2017,159(2):209-225.
[26]
周海航, 张李涛, 沈建国, 等. 重型颅脑损伤患者血清S100B, IL-6与颅内压力变化的相关性研究[J]. 中华全科医学,2017,15(4):574-576.
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