外周血C3aR1及NETs表达水平对脓毒症性凝血病的预测价值

Value of the expression levels of complement-3a receptor 1 and neutrophil extracellular traps in predicting sepsis-induced coagulopathy

摘要:

目的 研究补体C3a受体1（complement-3a receptor1, C3aR1）及中性粒细胞胞外诱捕网（neutrophil extracellular traps, NETs）对脓毒症性凝血病（sepsis-induced coagulopathy, SIC）的临床预测价值。方法 前瞻性纳入2022年6月—2023年6月于徐州医科大学附属徐州儿童医院就诊的脓毒症患儿78例为研究对象，根据是否发生SIC分为SIC组（36例）和非SIC组（42例）。比较两组临床资料、C3aR1和NETs水平，分析SIC发生的相关因素。应用受试者操作特征曲线（receiver operating characteristic curve, ROC曲线）评估C3aR1及NETs对SIC的预测效能。结果 SIC组C反应蛋白、白细胞介素（interleukin, IL）-6、IL-10、C3aR1及NETs水平高于非SIC组（P<0.05）。多因素logistic回归分析显示，C3aR1、NETs及IL-6升高与SIC发生密切相关（P<0.05）。ROC曲线分析显示，C3aR1联合NETs预测SIC的曲线下面积为0.913（P<0.05），高于C3aR1、IL-6的曲线下面积（P<0.05），与NETs的曲线下面积比较差异无统计学意义（P>0.05）。结论 SIC患儿外周血中C3aR1及NETs表达水平显著升高，二者表达水平对预测SIC发生具有较高的临床价值。

Abstract:

Objective To investigate the clinical value of complement-3a receptor 1 (C3aR1) and neutrophil extracellular traps (NETs) in predicting sepsis-induced coagulopathy (SIC).Methods A prospective study was conducted among 78 children with sepsis who attended Xuzhou Children's Hospital Affiliated to Xuzhou Medical University from June 2022 to June 2023. According to the presence or absence of SIC, they were divided into two groups: SIC (n=36) and non-SIC (n=42) . The two groups were compared in terms of clinical data and the levels of C3aR1 and NETs. The factors associated with the occurrence of SIC were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the performance of C3aR1 and NETs in predicting SIC.Results Compared with the non-SIC group, the SIC group had significantly higher levels of C-reactive protein, interleukin-6 (IL-6), interleukin-10, C3aR1, and NETs (P<0.05). The multivaiate logistic regression analysis showed that the increases in C3aR1, NETs, and IL-6 were closely associated with the occurrence of SIC (P<0.05). The ROC curve analysis showed that C3aR1 combined with NETs had an area under the curve (AUC) of 0.913 in predicting SIC (P<0.05), which was significantly higher than the AUC of C3aR1 or IL-6 (P<0.05), while there was no significant difference in AUC between C3aR1 combined with NETs and NETs alone (P>0.05).Conclusions There are significant increases in the expression levels of C3aR1 and NETs in the peripheral blood of children with SIC, and the expression levels of C3aR1 and NETs have a high clinical value in predicting SIC.