Inhibition effect of induced normal temperature control on activation of NLRP3 signaling pathway in severe multiple injury
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摘要: 目的 探讨诱导常温控制对严重多发伤核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)信号通路激活的抑制作用。 方法 选取2018年2月—2019年1月郑州大学附属郑州中心医院收治的90例严重多发伤患者,按照随机数字表法分为研究组和对照组,各45例,2组分别在常规治疗方案同时给予亚低温控制、诱导常温控制。统计2组住院期间病死率,比较存活患者治疗前后急性生理与慢性健康评分(APACHEⅡ)、格拉斯哥昏迷(GCS)评分、外周血单个核细胞(PBMC)中NLRP3、半胱氨酸天冬氨酸蛋白水解酶-1(caspase-1)相对表达量、外周血中白介素(IL)-1β、IL-18水平;统计降温及复温期间不良反应发生率。 结果 研究组住院期间病死率为8.89%,与对照组(13.33%)比较,差异无统计学意义(P>0.05);治疗后2组APACHEⅡ评分均降低,且研究组低于对照组(均P<0.05);治疗后2组GCS评分均升高,且研究组高于对照组(均P<0.05);治疗后2组PBMC中NLRP3、caspase-1相对表达量、外周血中IL-1β、IL-18水平均降低,且研究组低于对照组(均P<0.05);研究组不良反应发生率为2.22%,低于对照组的17.78%(P<0.05)。 结论 诱导常温控制可能通过抑制NLRP3-caspase-1-IL-1β/IL-18信号通路的激活而促进严重多发伤患者康复,减少降温及复温期间不良反应,安全性高。
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关键词:
- 诱导常温控制 /
- 严重多发伤 /
- 核苷酸结合寡聚化结构域样受体蛋白3 /
- 激活
Abstract: Objective To investigate the inhibitory effect of induced normal temperature control on the activation of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3) signaling pathway in severe multiple injury. Methods Total 90 patients with severe multiple injury admitted to the emergency department of our hospital from February 2018 to January 2019 were randomly divided into study group and control group, 45 patients with each group. The two groups were given mild hypothermia control and induced normal temperature control at the same time as the conventional treatment regimen. The mortality rate of the two groups was calculated. The acute physiology and chronic health evaluation(APACHE Ⅱ), Glasgow Coma Scale(GCS), the relative expression of NLRP3 and caspase-1 in peripheral blood mononuclear cells(PBMC), IL-1β and IL-18 levels in peripheral blood were compared before and after treatment. The incidence of adverse reactions during cooling and rewarming were analyzed. Results The mortality rate in the study group was 8.89% while that in the control group was 13.33%, there was no significant difference(P>0.05). After treatment, the APACHEⅡ score of the two groups decreased, and the study group was lower than the control group(all P<0.05). The GCS scores of the two groups increased after treatment, and the study group was higher than the control group(all P<0.05). After treatment, the relative expressions of NLRP3 and caspase-1 in PBMC, the levels of IL-1 β and IL-18 in peripheral blood of the two groups were decreased, and the levels of the study group were lower than those of the control group(all P<0.05). The incidence of adverse reactions in the study group(2.22%) was lower than that in the control group(17.78%), P<0.05. Conclusion Induced normal temperature control may promote the rehabilitation of patients with severe multiple injury by activating NLRP3-caspase-1-IL-1β/IL-18 signaling pathway, reduce adverse reactions during cooling and rewarming, and have high safety.
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