2024 年第 3 期 第 19 卷

α7烟碱型乙酰胆碱受体mRNA和乙酰胆碱及胆碱酯酶对急性呼吸窘迫综合征患者早期病情评估及预测其发生多器官功能障碍综合征的价值研究

The value of α7 nicotinic acetylcholine receptor mRNA, acetylcholine and cholinesterase in early disease assessment and prediction of multiple organ dysfunction syndrome in patients with acute respiratory distress syndrome

作者：杨小蕾杨义

英文作者：Yang Xiaolei Yang Yi

单位：重庆市人民医院重症医学科，重庆401121

英文单位：Intensive Care Unit Chongqing General Hospital Chongqing 401121 China

关键词：急性呼吸窘迫综合征；α7烟碱型乙酰胆碱受体；乙酰胆碱；胆碱酯酶；多器官功能障碍综合征

英文关键词：Acuterespiratorydistresssyndrome;α7nicotinicacetylcholinereceptor;Acetylcholine; Cholinesterase;Multipleorgandysfunctionsyndrome

• 摘要：

• 目的 探讨外周血中α7烟碱型乙酰胆碱受体(α7nAchR)mRNA、乙酰胆碱、胆碱酯酶对急性呼吸窘迫综合征(ARDS)患者早期病情评估及预测其发生多器官功能障碍综合征(MODS)的价值。方法 本研究采用前瞻性观察性研究方法。选取2020年8月至2022年10月在重庆市人民医院重症医学科住院的需要呼吸机治疗的ARDS患者65例。于确诊ARDS后24 h内检测外周血单个核细胞α7nAchR mRNA及外周血乙酰胆碱和胆碱酯酶水平，并进行与患者疾病严重程度有关的急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）和MODS评分。观察治疗28 d期间MODS发生情况，据此分为MODS组（31例）和非MODS组（34例）。比较2组上述临床资料。分析α7nAchR mRNA、乙酰胆碱、胆碱酯酶水平与APACHEⅡ、MODS评分的相关性。绘制受试者工作特征（ROC）曲线，分析α7nAchR mRNA、乙酰胆碱、胆碱酯酶对ARDS患者发生MODS的预测价值。结果 MODS组α7nAchR mRNA、乙酰胆碱、胆碱酯酶水平明显低于非MODS组［0.23(0.12，0.32)比0.69(0.58，0.87)、（201±79）mg/L比（317±80）mg/L、2 319(1 893，4 241)U/L比4 788(3 831，5 379)U/L］，差异均有统计学意义（均P<0.001）。α7nAchR mRNA、乙酰胆碱、胆碱酯酶水平与APACHEⅡ、MODS评分均呈负相关（APACHEⅡ评分：r=-0.789、-0.650、-0.635，均P<0.001；MODS评分：r=-0.832、-0.658、-0.674，均P<0.001）。α7nAchR mRNA、乙酰胆碱、胆碱酯酶预测ARDS患者发生MODS的ROC曲线下面积、敏感度、特异度分别为0.964、100.0%、83.9%，0.848、88.2%、77.4%，0.845、100.0%、58.1%；前二者预测价值较高。结论 α7nAchR mRNA、乙酰胆碱、胆碱酯酶水平可反映ARDS患者早期病情及预测MODS发生，其中α7nAchR mRNA、乙酰胆碱预测价值较高。

• Objective To explore the value of α7 nicotinic acetylcholine receptor(α7nAchR) mRNA, acetylcholine and cholinesterase in early disease assessment and prediction of multiple organ dysfunction syndrome(MODS) in patients with acute respiratory distress syndrome(ARDS). Methods Prospective observational study was adopted. Totally of 65 ARDS patients who needed ventilators admitted to the Intensive Care Unit, Chongqing General Hospital from August 2020 to October 2022 were selected. Within 24 h after confirmation of ARDS, the levels of α7nAchR mRNA in peripheral blood mononuclear cells, peripheral blood acetylcholine and cholinesterase were detected, and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) and MODS scores related to the severity of the patient′s disease were conducted. During the 28 d treatment period, the occurrence of MODS was observed and then divided into MODS group(31 cases) and non MODS group(34 cases). The above clinical data were compared between the two groups. The correlation between α7nAchR mRNA, acetylcholine, cholinesterase and APACHE Ⅱ, MODS scores were analyzed. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of α7nAchR mRNA, acetylcholine, and cholinesterase in the occurrence of MODS in patients with ARDS. Results The levels of α7nAchR mRNA, acetylcholine, and cholinesterase in MODS group were significantly lower than those in non MODS group［0.23(0.12, 0.32) vs 0.69(0.58, 0.87), (201±79)mg/L vs (317±80)mg/L, 2 319(1 893, 4 241)U/L vs 4 788(3 831, 5 379)U/L］(all P<0.001). The levels of α7nAchR mRNA, acetylcholine and cholinesterase were negatively correlated with APACHE Ⅱ and MODS scores(APACHEⅡ score: r=-0.789, -0.650, -0.635, all P<0.001; MODS score: r=-0.832, -0.658, -0.674, all P<0.001). The areas under the ROC curve, sensitivities, and specificities of α7nAchR mRNA, acetylcholine and cholinesterase for predicting MODS in ARDS patients were 0.964, 100.0%, 83.9%; 0.848, 88.2%, 77.4%; 0.845, 100.0%, 58.1%, respectively. α7nAchR mRNA and acetylcholine have higher predictive value. Conclusion The α7nAchR mRNA, acetylcholine, and cholinesterase can reflect the condition of ARDS patients at an early stage and predict the occurrence of MODS, of which α7nAchR mRNA and acetylcholine have a high predictive value.