中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
13期
906-911
,共6页
朱英%邱海波%刘京涛%王宇%林洪远%许媛%姜利%石岩%朱熹%宁渡%程芮%谢志毅%马朋林
硃英%邱海波%劉京濤%王宇%林洪遠%許媛%薑利%石巖%硃熹%寧渡%程芮%謝誌毅%馬朋林
주영%구해파%류경도%왕우%림홍원%허원%강리%석암%주희%저도%정예%사지의%마붕림
脓毒症%一氧化氮合酶%基因%预后
膿毒癥%一氧化氮閤酶%基因%預後
농독증%일양화담합매%기인%예후
Sepsis%Nitric-oxide synthase%Gene%Prognosis
目的 探讨一氧化氮合酶(eNOS)894G→T,-786T→C基因多态性与脓毒症患者疾病严重程度及预后的相关性.方法 于2007年4月至2009年5月,在北京9个教学医院ICU随机收集严重脓毒症患者117例,应用PCR-RLFP及PCR-SSCP方法检测eNOS 894G→T,-786T→C等位基因和基因型.记录患者一般情况、致病微生物,入ICU后24 h内急性心理学与慢性健康状况评分系统Ⅱ(APACHE)Ⅱ评分、7 d内SOFA评分、感染性休克发生率、致休克时间(从发生感染至出现休克时间)、休克持续时间、人ICU后7及28 d病死率.结果 eNOS 894 G→T基因多态性中基因型GT携带者感染性休克的发生率较基因型GG携带者有增加趋势(87%vs 68.1%,P=0.071),且致休克时间明显缩短[1.0(0.1-6.5)d vs 2.0(0.10-27.0)d,中位数(范围),P<0.05].此类患者APACHE Ⅱ(24±7 vs 19±7)及序贯器官衰竭分析(SOFA)评分(9±3 vs 5±3)显著升高(P<0.05,P<0.001),7 d和28 d病死率显著增高(34.8%vs 0%,P<0.001;78.3%vs 23.4%,P<0.001).多因素分析发现,年龄、SOFA评分以及基因型GT为影响严重脓毒症预后的独立高危风险因素.本研究未发现eNOS 0786T→C基因多态性与脓毒症患者疾病严重程度及预后存在相关性.结论 eNOS 894C→T(而非-786T→C)基因多态性与脓毒症患者疾病严重程度及预后存在密切关系.基因型GT携带者器官功能损害更加显著,并且与感染性休克的发病过程关系密切.
目的 探討一氧化氮閤酶(eNOS)894G→T,-786T→C基因多態性與膿毒癥患者疾病嚴重程度及預後的相關性.方法 于2007年4月至2009年5月,在北京9箇教學醫院ICU隨機收集嚴重膿毒癥患者117例,應用PCR-RLFP及PCR-SSCP方法檢測eNOS 894G→T,-786T→C等位基因和基因型.記錄患者一般情況、緻病微生物,入ICU後24 h內急性心理學與慢性健康狀況評分繫統Ⅱ(APACHE)Ⅱ評分、7 d內SOFA評分、感染性休剋髮生率、緻休剋時間(從髮生感染至齣現休剋時間)、休剋持續時間、人ICU後7及28 d病死率.結果 eNOS 894 G→T基因多態性中基因型GT攜帶者感染性休剋的髮生率較基因型GG攜帶者有增加趨勢(87%vs 68.1%,P=0.071),且緻休剋時間明顯縮短[1.0(0.1-6.5)d vs 2.0(0.10-27.0)d,中位數(範圍),P<0.05].此類患者APACHE Ⅱ(24±7 vs 19±7)及序貫器官衰竭分析(SOFA)評分(9±3 vs 5±3)顯著升高(P<0.05,P<0.001),7 d和28 d病死率顯著增高(34.8%vs 0%,P<0.001;78.3%vs 23.4%,P<0.001).多因素分析髮現,年齡、SOFA評分以及基因型GT為影響嚴重膿毒癥預後的獨立高危風險因素.本研究未髮現eNOS 0786T→C基因多態性與膿毒癥患者疾病嚴重程度及預後存在相關性.結論 eNOS 894C→T(而非-786T→C)基因多態性與膿毒癥患者疾病嚴重程度及預後存在密切關繫.基因型GT攜帶者器官功能損害更加顯著,併且與感染性休剋的髮病過程關繫密切.
목적 탐토일양화담합매(eNOS)894G→T,-786T→C기인다태성여농독증환자질병엄중정도급예후적상관성.방법 우2007년4월지2009년5월,재북경9개교학의원ICU수궤수집엄중농독증환자117례,응용PCR-RLFP급PCR-SSCP방법검측eNOS 894G→T,-786T→C등위기인화기인형.기록환자일반정황、치병미생물,입ICU후24 h내급성심이학여만성건강상황평분계통Ⅱ(APACHE)Ⅱ평분、7 d내SOFA평분、감염성휴극발생솔、치휴극시간(종발생감염지출현휴극시간)、휴극지속시간、인ICU후7급28 d병사솔.결과 eNOS 894 G→T기인다태성중기인형GT휴대자감염성휴극적발생솔교기인형GG휴대자유증가추세(87%vs 68.1%,P=0.071),차치휴극시간명현축단[1.0(0.1-6.5)d vs 2.0(0.10-27.0)d,중위수(범위),P<0.05].차류환자APACHE Ⅱ(24±7 vs 19±7)급서관기관쇠갈분석(SOFA)평분(9±3 vs 5±3)현저승고(P<0.05,P<0.001),7 d화28 d병사솔현저증고(34.8%vs 0%,P<0.001;78.3%vs 23.4%,P<0.001).다인소분석발현,년령、SOFA평분이급기인형GT위영향엄중농독증예후적독립고위풍험인소.본연구미발현eNOS 0786T→C기인다태성여농독증환자질병엄중정도급예후존재상관성.결론 eNOS 894C→T(이비-786T→C)기인다태성여농독증환자질병엄중정도급예후존재밀절관계.기인형GT휴대자기관공능손해경가현저,병차여감염성휴극적발병과정관계밀절.
Objective To investigate the association of eNOS 894G→T, -786T→C gene polymorphisms with disease severity and outcome in septic patients. Methods A total of 117 patients with severe sepsis were randomly selected from ICUs at 9 academic hospitals in Beijing during April 2007 to May 2009. PCR-RFLP and PCR-SSCP were used to analyze the alleles and genotypes in eNOS 894G→T and - 786T→C gene polymorphisms. Recorded clinical data included demographics, pathogens, APACHE Ⅱ score within 24 hours and SOFA score within 7 days after ICU admission, percentage of shock patients, days to shock onset (from infection to shock onset ), duration of shock and the mortality at Days 7 and 28. Results In comparison with genotype GT carriers, the patients with genotype GT in eNOS 894G→T polymorphism had a incremental trend in frequency of shock (87% vs 68. 1 % , P = 0. 071) and a significantly shortened days to shock onset [1. 0(0.1-6. 5)vs 2. 0 (0.10-27.0) days, median (range), P<0.05]. Those patients had been shown to have a significantly high APACHE Ⅱ score (23. 61 ± 7. 00 vs 19. 50 ± 6.99, P<0.05), SOFA score(9. 43 ±3.42 vs 5. 26 ±2. 94 , P <0.001)and mortality at Day 7 (34.8% vs 0% , P <0. 001) and Day 28 (78. 3% vs 23. 4% , P <0.001). Multivariate analyses revealed that age in years, SOFA score and genotype GT in eNOS 894G→T polymorphism were independent high-risk factors for the outcome in septic patients. However, eNOS -786T→C gene polymorphism was not associated with disease severity and outcome in septic patients. Conclusion Carriage of genotype GT in eNOS 894G→T polymorphism is associated with the occurrence of shock and impaired organ function.
