评估血清 HSP90α 在脓毒症患者中的诊断和预后价值：一项回顾性研究。
Evaluation of the diagnostic and prognostic values of serum HSP90α in sepsis patients: a retrospective study.
机构信息
Department of Clinical Laboratory, School of Clinical Medicine, Dali University, Dali, Yunnan, China.
Department of Gastroenterology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China.
出版信息
PeerJ. 2022 Mar 10;10:e12997. doi: 10.7717/peerj.12997. eCollection 2022.
BACKGROUND
Sepsis is a serious syndrome that is caused by immune responses dysfunction and leads to high mortality. The abilities of heat shock protein 90α (HSP90α) in assessing the diagnosis and prognosis in patients with sepsis remain ill-defined to date. We conducted a study to reveal the possible clinical applications of HSP90α as biomarker for the diagnosis and prognosis in patients with sepsis.
METHODS
In total, 150 patients of sepsis, 110 patients without sepsis admitted to ICU and 110 healthy subjects were involved in this study. The serum HSP90α contents, sequential organ failure assessment (SOFA) scores, procalcitonin (PCT), and short-term survival status of the participants were measured and compared. Logistic and linear regression models adjusting for potential confounders were used to examine the association of HSP90α with sepsis survival. Moreover, serum IL-1β, IL-18, MIP-3α, and ENA-78 were also determined. Finally, Spearman correlation analysis was employed to reveal a possible mechanism that HSP90α contributed to the short-term deaths.
RESULTS
Serum HSP90α levels in sepsis patients were higher than those in ICU controls and healthy controls ( < 0.001), and even increased in patients who died within 28 days ( < 0.001). Logistic and linear regression models identified HSP90α was an independent risk factors for sepsis mortality. Receiver operating characteristic (ROC) analysis displayed that HSP90α had a considerable predictive performance for sepsis outcome, with an area under curve (AUC) value up to 0.79. Survival analysis demonstrated that the mortality of sepsis individuals at 28 days was positively associated with HSP90α levels, especially the levels of HSP90α were greater than 120 ng/mL ( < 0.001). Moreover, among sepsis patients, those who died had notably elevated cytokines, IL-1β, IL-18, and chemokines, MIP-3α, ENA-78, relative to survivors. Further correlation analysis demonstrated that there was a nominally positive correlation between HSP90α and IL-1β, IL-18, and MIP-3α.
CONCLUSION
HSP90α is of favorable clinical significance in sepsis diagnosis and prognosis, laying a foundation for future clinical applications.
背景
脓毒症是一种由免疫反应功能障碍引起的严重综合征，导致高死亡率。热休克蛋白 90α（HSP90α）在评估脓毒症患者的诊断和预后方面的能力至今仍未明确。我们进行了一项研究，旨在揭示 HSP90α作为脓毒症患者诊断和预后生物标志物的可能临床应用。
方法
本研究共纳入 150 例脓毒症患者、110 例 ICU 中无脓毒症患者和 110 例健康对照者。测量并比较了参与者的血清 HSP90α含量、序贯器官衰竭评估（SOFA）评分、降钙素原（PCT）和短期生存状况。使用调整潜在混杂因素的逻辑和线性回归模型来检验 HSP90α与脓毒症生存的相关性。此外，还测定了血清白细胞介素-1β（IL-1β）、白细胞介素-18（IL-18）、巨噬细胞炎性蛋白-3α（MIP-3α）和内皮中性粒细胞激活肽-78（ENA-78）。最后，采用 Spearman 相关分析揭示 HSP90α导致短期死亡的可能机制。
结果
脓毒症患者的血清 HSP90α水平高于 ICU 对照组和健康对照组（<0.001），甚至在 28 天内死亡的患者中也升高（<0.001）。逻辑和线性回归模型确定 HSP90α是脓毒症死亡率的独立危险因素。受试者工作特征（ROC）分析显示，HSP90α对脓毒症结局具有较好的预测性能，曲线下面积（AUC）值高达 0.79。生存分析表明，脓毒症患者 28 天的死亡率与 HSP90α水平呈正相关，特别是 HSP90α水平大于 120ng/ml（<0.001）。此外，在脓毒症患者中，死亡患者的细胞因子、白细胞介素-1β、白细胞介素-18 和趋化因子 MIP-3α、ENA-78 明显升高，与存活者相比。进一步的相关分析表明，HSP90α与白细胞介素-1β、白细胞介素-18 和 MIP-3α之间存在名义上的正相关。
结论
HSP90α在脓毒症的诊断和预后中有较好的临床意义，为其未来的临床应用奠定了基础。
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