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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/OL]. 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/OL]. 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
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