连续血液净化治疗对成人脓毒症患者外周血单核细胞mtDNA及线粒体复合物Ⅴ的影响

李智鑫; 吕铁; 金烈洲; 陈铝坚; 应利君

doi:10.16766/j.cnki.issn.1674-4152.004360

连续血液净化治疗对成人脓毒症患者外周血单核细胞mtDNA及线粒体复合物Ⅴ的影响

doi: 10.16766/j.cnki.issn.1674-4152.004360

绍兴市人民医院内科重症监护室，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2023KY1261

详细信息

通讯作者:
李智鑫，E-mail：lzxkxmyt@163.com

中图分类号: R631 R459.5
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出版历程
- 收稿日期: 2025-03-05
- 网络出版日期: 2026-04-11

Effects of continuous blood purification therapy on mitochondrial DNA and mitochondrial complex Ⅴ in peripheral blood mononuclear cells of sepsis patients

Department of Medical Intensive Care Unit, Shaoxing People ' s Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的脓毒症患者单核细胞线粒体功能受损，本研究通过观察连续性血液净化(CBP)治疗对脓毒症患者单核细胞线粒体DNA(mtDNA)及复合物Ⅴ的影响，探讨CBP治疗是否有助于改善脓毒症患者单核细胞线粒体功能。方法采用前瞻性队列研究分析2023年1月—2024年6月绍兴市人民医院重症医学科收治的150例脓毒症患者的临床资料，根据患者是否接受CBP治疗分为CBP组(82例)及非CBP组(68例)。分别在入组及治疗48 h时，检测单核细胞mtDNA、线粒体复合物Ⅴ水平；在2组中选择年龄及疾病严重程度相近的患者各20例，治疗48 h后分离出单核细胞体外培养，脂多糖(LPS)刺激后4、8、12、24、48 h检测mtDNA、线粒体复合物Ⅴ、TNF-α及IL-6水平。结果 2组患者治疗48 h时mtDNA水平较入组时均明显下调，且CBP组mtDNA水平明显低于非CBP组(303.74±90.97 vs. 534.68±113.78，P < 0.01)；CBP组治疗48 h时线粒体复合物Ⅴ水平较入组时明显上升[(101.12±33.46)pg/mL vs. (74.04±25.97)pg/mL，P < 0.01]，非CBP组较入组时明显下降[(57.54±13.89)pg/mL vs. (72.84±25.30)pg/mL，P < 0.01]；单核细胞体外孵育后4、8 h，CBP组mtDNA、线粒体复合物Ⅴ、TNF-α及IL-6水平均明显高于非CBP组(P < 0.01)。结论 CBP治疗可能有助于改善脓毒症患者单核细胞线粒体功能。
- 脓毒症 /
- 连续性血液净化 /
- 线粒体DNA /
- 线粒体复合物Ⅴ
Abstract: Objective To investigate the effects of continuous blood purification (CBP) therapy on mitochondrial DNA (mtDNA) and complex Ⅴ of monocytes in patients with sepsis, and to evaluate whether CBP therapy can improve mitochondrial function. Methods A prospective cohort study was conducted in 2023 to analyze the clinical data of 150 patients with sepsis admitted to the Department of Critical Care Medicine of Shaoxing People ' s Hospital from January 2023 to June 2024. Patients were divided into a CBP group (82 cases) and a non-CBP group (68 cases) according to whether the patients received CBP treatment. After 48 hours of treatment, the levels of mtDNA and mitochondrial complex Ⅴ in monocytes were detected in both groups. Twenty patients with similar age and disease severity were selected from each group. Monocytes were isolated 48 hours after treatment and culture in vitro. The levels of mtDNA, mitochondrial complex Ⅴ, TNF-α, and IL-6 were detected at 4, 8, 12, 24, and 48 hours after LPS stimulation. Results The mtDNA levels in both groups were significantly down-regulated compared with that in the group after 48 hours of treatment, and the mtDNA level in the CBP group was significantly lower than that in the non-CBP group (303.74±90.97 vs. 534.68±113.78, P < 0.01). The level of mitochondrial complex Ⅴ in the CBP group after 48-hour treatment was significantly higher than that in the control group [(101.12±33.46) pg/mL vs. (74.04±25.97) pg/mL, P < 0.01]. However, the complex Ⅴ levels were significantly decreased in the non-CBP group compared with the entry group [(57.54±13.89) pg/mL vs. (72.84±25.30) pg/mL, P < 0.01]. The levels of mtDNA, mitochondrial complex Ⅴ, TNF-α, and IL-6 of monocytes in the CBP group were significantly higher than those in the non-CBP group at 4 and 8h after incubation (P < 0.01). Conclusion CBP therapy may help improve monocyte mitochondrial function in patients with sepsis.
- Sepsis /
- Continuous blood purification /
- Mitochondrial DNA /
- Mitochondrial complex Ⅴ

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表 1 2组脓毒症患者一般资料比较

Table 1. Comparison of general data between the two groups of sepsis patients

组别	例数	原发感染部位(肺部/其他, 例)	性别(男性/女性, 例)	年龄(x±s, 岁)	APECHEⅡ评分(x±s, 分)	SOFA评分(x±s, 分)	ICU住院时间(x±s, d)	总住院时间(x±s, d)	28 d病死[例(%)]
CBP组	82	57/25	47/35	50.66±10.81	20.64±6.52	6.18±1.94	13.01±5.74	20.4±8.63	16(19.7)
非CBP组	68	48/20	39/29	51.64±11.05	21.22±7.24	6.65±2.06	17.60±6.56	26.5±9.36	22(32.5)
统计量		0.684^a	0.460^a	0.826^b	0.306^b	1.082^b	2.379^b	2.946^b	4.650^a
P值		0.506	0.651	0.416	0.581	0.276	0.026	0.015	0.003
注：^a为χ²值，^b为t值。

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表 2 2组脓毒症患者入组时及治疗48 h的mtDNA、线粒体复合物Ⅴ比较(x±s)

Table 2. Comparison of mtDNA and mitochondrial complex Ⅴ between two groups of sepsis patients at admission and 48 h after treatment (x±s)

组别	例数	mtDNA		t值	P值	线粒体复合物Ⅴ(pg/mL)		t值	P值
组别	例数	入组时	治疗48 h	t值	P值	入组时	治疗48 h	t值	P值
CBP组	82	638.48±123.95	303.74±90.97	25.431	< 0.001	74.04±25.97	101.12±33.46	10.273	< 0.001
非CBP组	68	634.73±122.09	534.68±113.78	13.982	< 0.001	72.84±25.30	57.54±13.89	14.818	< 0.001
统计量		1.263^a	223.360^b			0.926^a	156.542^b
P值		0.230	< 0.001			0.420	< 0.001
注：^a为t值，^b为F值。

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表 3 2组脓毒症患者入组时及治疗48 h的APACHEⅡ评分、SOFA评分比较(x±s, 分)

Table 3. Comparison of APACHEⅡ score and SOFA between the two groups of sepsis patients at admission and 48 h after treatment (x±s, points)

组别	例数	APACHEⅡ评分		t值	P值	SOFA评分		t值	P值
组别	例数	入组时	治疗48 h	t值	P值	入组时	治疗48 h	t值	P值
CBP组	82	20.64±6.32	13.52±4.26	4.242	< 0.001	6.18±1.94	2.68±0.55	5.654	< 0.001
非CBP组	68	21.22±6.54	18.34±5.61	2.615	0.024	6.65±2.06	5.31±1.47	2.872	0.016
统计量		0.313^a	63.505^b			1.075^a	36.827^b
P值		0.881	< 0.001			0.276	0.002
注：^a为t值，^b为F值。

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表 4 2组脓毒症患者单核细胞mtDNA、线粒体复合物V、TNF-α、IL-6水平比较(x±s)

Table 4. Comparison of mtDNA, mitochondrial complex V, TNF-α and IL-6 between the two groups of sepsis patients (x±s)

组别	例数	mtDNA
组别	例数	4 h	8 h	12 h	24 h	48 h
CBP组	20	346.53±88.37	376.51±92.34^b	475.27±105.30^bc	523.22±112.28^bcd	87.30±32.61
非CBP组	20	239.40±78.53^a	246.73±80.27^ab	142.80±46.27^abc	58.49±17.61^abcd	0

组别	例数	线粒体复合物Ⅴ(pg/mL)
组别	例数	4 h	8 h	12 h	24 h	48 h
CBP组	20	153.52±53.61	95.82±34.37^b	72.36±26.22^bc	36.60±13.65^bcd	22.43±8.48
非CBP组	20	58.57±18.30^a	41.35±14.57^ab	28.45±11.05^abc	11.06±4.37^abcd	0

组别	例数	TNF-α(pg/mL)
组别	例数	4 h	8 h	12 h	24 h	48 h
CBP组	20	44.29±15.84	65.51±23.86^b	95.86±32.38^bc	89.29±30.68^bcd	47.35±16.90^bcde
非CBP组	20	29.45±10.72^a	46.70±16.53^ab	42.86±14.82^abc	28.49±9.60^abcd	11.24±4.57^abcde

组别	例数	IL-6(pg/mL)
组别	例数	4 h	8 h	12 h	24 h	48 h
CBP组	20	75.76±27.04	93.57±32.80^b	125.75±40.22^bc	158.82±54.05^bcd	92.70±32.57^bcde
非CBP组	20	54.97±16.22^a	71.70±25.07^ab	63.45±19.41^abc	35.06±12.55^abcd	20.51±7.48^abcde
注：与CBP组比较，^aP < 0.05；与孵育4 h比较，^bP < 0.05；与孵育8 h比较，^cP < 0.05；与孵育12 h比较，^dP < 0.05，与孵育24 h比较，^eP < 0.05。mtDNA，F_组间=267.535，P_组间 < 0.001；F_时间=1 766.823，P_时间 < 0.001；F_交互=226.463, P_交互 < 0.001。线粒体复合物Ⅴ，F_组间=182.350，P_组间 < 0.001；F_时间=1 306.517，P_时间 < 0.001；F_交互=167.408, P_交互 < 0.001。TNF-α，F_组间=92.581，P_组间 < 0.001；F_时间=1 150.650，P_时间 < 0.001；F_交互=113.715, P_交互 < 0.001。IL-6，F_组间=119.236，P_组间 < 0.001；F_时间=1 182.794，P_时间 < 0.001；F_交互=264.628, P_交互 < 0.001。

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