Gu Xiaoling, Yao Yanwen, Wu Guannan, Lv Tangfeng, Luo Liang, Song Yong
Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
PLoS One. 2013 Aug 20;8(8):e72834. doi: 10.1371/journal.pone.0072834. eCollection 2013.
Mitochondrial DNA (mtDNA), a newly identified damage-associated molecular pattern, has been observed in trauma patients, however, little is known concerning the relationship between plasma mtDNA levels and concrete post-traumatic complications, particularly systemic inflammatory response syndrome (SIRS). The aim of this study is to determine whether plasma mtDNA levels are associated with injury severity and cloud predict post-traumatic SIRS in patients with acute traumatic injury.
Eighty-six consecutive patients with acute traumatic injury were prospectively enrolled in this study. The plasma mtDNA concentration was measured by a real-time, quantitative PCR assay for the human ND2 gene. The study population's clinical and laboratory data were analyzed.
The median plasma mtDNA was higher in trauma patients than in healthy controls (865.196 (251.042-2565.40)pg/ml vs 64.2147 (43.9049-80.6371)pg/ml, P<0.001) and was independently correlated with the ISS score (r=0.287, P<0.001). The plasma mtDNA concentration was also significantly higher in patients who developed post-traumatic SIRS than in patients who did not (1774.03 (564.870-10901.3)pg/ml vs 500.496 (145.415-1285.60)pg/ml, P<0.001). Multiple logistic regression analysis revealed that the plasma mtDNA was an independent predictors for post-traumatic SIRS (OR, 1.183 (95%CI, 1.015-1.379), P=0.032). Further ROC analysis demonstrated that a high plasma mtDNA level predicted post-traumatic SIRS with a sensitivity of 67% and a specificity of 76%, with a cut-off value of 1.3185 µg/ml being established, and the area under the ROC curves (AUC) was 0.725 (95% CI 0.613-0.837).
Plasma mtDNA was an independent indictor with moderate discriminative power to predict the risk of post-traumatic SIRS.
线粒体DNA(mtDNA)是一种新发现的损伤相关分子模式,已在创伤患者中被观察到,然而,关于血浆mtDNA水平与具体创伤后并发症之间的关系,尤其是全身炎症反应综合征(SIRS),人们知之甚少。本研究的目的是确定血浆mtDNA水平是否与损伤严重程度相关,并能否预测急性创伤性损伤患者创伤后SIRS的发生。
本研究前瞻性纳入了86例连续的急性创伤性损伤患者。通过针对人类ND2基因的实时定量PCR检测法测量血浆mtDNA浓度。对研究人群的临床和实验室数据进行分析。
创伤患者的血浆mtDNA中位数高于健康对照组(865.196(251.042 - 2565.40)pg/ml对64.2147(43.9049 - 80.6371)pg/ml,P<0.001),且与损伤严重度评分(ISS)独立相关(r = 0.287,P<0.001)。发生创伤后SIRS的患者血浆mtDNA浓度也显著高于未发生者(1774.03(564.870 - 10901.3)pg/ml对500.496(145.415 - 1285.60)pg/ml,P<0.001)。多因素逻辑回归分析显示,血浆mtDNA是创伤后SIRS的独立预测因子(比值比,1.183(95%可信区间,1.015 - 1.379),P = 0.032)。进一步的ROC分析表明,高血浆mtDNA水平预测创伤后SIRS的敏感性为67%,特异性为76%,确定的截断值为1.3185 µg/ml,ROC曲线下面积(AUC)为0.725(95%可信区间0.613 - 0.837)。
血浆mtDNA是预测创伤后SIRS风险的具有中等判别能力的独立指标。