| 郑文敏,田元元,刘真义.肝硬化上消化道出血病人血清 FOXM1和 SIRT1表达改变与病情严重程度及预后的关系研究[J].安徽医药,2025,29(8):1665-1669. |
| 肝硬化上消化道出血病人血清 FOXM1和 SIRT1表达改变与病情严重程度及预后的关系研究 |
| Study on the changes of serum FOXM1 and SIRT1 expression in patients with upper gastrointestinal hemorrhage due to cirrhosis and their relationship with severity and prognosis |
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| DOI：10.3969/j.issn.1009-6469.2025.08.037 |
| 中文关键词: 肝硬化 上消化道出血 叉头框蛋白 M1 沉默信息调节因子 2相关酶 1 预后 |
| 英文关键词: Liver cirrhosis Upper gastrointestinal hemorrhage Forkhead box protein M1 Silent information regulator 2-related enzyme 1 Prognosis |
| 基金项目:四川省科技成果转移转化项目( 2021ZYZFSY01) |
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| 中文摘要: |
| 目的探讨血清叉头框蛋白 M1(FOXM1)和沉默信息调节因子 2相关酶 1(SIRT1)在肝硬化上消化道出血病人中的表达水平，以及与病情严重程度和预后的关系。方法前瞻性选取 2019年 1月至 2022年 5月海南省第三人民医院住院治疗的肝硬化上消化道出血病人 78例进行研究，根据病情严重程度分为轻度组( n=28)、中度组( n=34)和重度组( n=16)；根据病人预后情况分为生存组( n=59)和死亡组( n=19)；另选取同期与肝硬化上消化道出血病人年龄、性别等临床资料一致的 78例健康体检者作为健康组。比较各组血清 FOXM1、SIRT1表达水平； Pearson法分析血清中 FOXM1与 SIRT1的相关性； logistic回归分析肝硬化上消化道出血病人预后的影响因素；受试者操作特征曲线( ROC曲线)分析血清 FOXM1、SIRT1水平对病人预后死亡的评估价值。结果健康组、轻度组、中度组、重度组病人血清 FOXM1的表达水平( 0.96±0.10、1.07±0.21、2.36±0.45、3.26±0.78)逐渐增加(P<0.05)SIRT1表达水平［(2 542.65±258.68)ng/L、(2 163.84±184.76)ng/L、(1 658.72±148.53)ng/L、(968.41±126.81)ng/L］逐渐降低(P<0.05)。，与生存组相比，死亡组病人血清 SIRT1表达水平显著降低(P<0.05)，FOXM1表达水平、凝血酶原时间、血红蛋白、肝功能 Child分级为 C级占比显著升高( P<0.05)。肝硬化上消化道出血病人血清 FOXM1水平与血清 SIRT1水平呈显著负相关(r=.0.61，P<0.001)。FOXM1、凝血酶原时间、血红蛋白、肝功能 Child分级为 C级是肝硬化上消化道出血病人预后死亡的危险因素， SIRT1是保护因素(P<0.05)。血清 FOXM1、SIRT1二者联合预测病人预后的曲线下面积(AUC)为 0.99，灵敏度为 94.74%，特异度为 93.12%，优于各自单独预测( Z联合检测 -FOXM1=2.42、Z联合检测 -SIRT1=2.14，P=0.016、0.032)。结论血清 FOXM1和 SIRT1水平与肝硬化上消化道出血病人病情严重程度和预后密切相关，二者联合对肝硬化上消化道出血病人预后预测有较好参考价值。 |
| 英文摘要: |
| Objective To investigate the expression level of serum forkhead box protein M1 (FOXM1) and silent information regulato-ry factor 2-related enzyme 1 (SIRT1) in patients with upper gastrointestinal hemorrhage due to cirrhosis, and their relationship with theseverity and prognosis of the disease.Methods Seventy-eight patients with cirrhosis and Upper gastrointestinal bleeding hospitalizedin the Third People's Hospital of Hainan Province from January 2019 to May 2022 were prospectively selected for the study, accordingto the severity of the disease, they were grouped into mild group (n=28), moderate group (n=34) and severe group (n=16); the patients were grouped into survival group (n=59) and death group (n=19) according to their prognosis, meantime, 78 healthy subjects with thesame age, gender and other clinical data as patients with cirrhosis of the upper digestive tract bleeding were selected as the health.group. The expression levels of FOXM1 and SIRT1 in serum of each group were compared; Pearson method was applied to analyze thecorrelation between serum FOXM1 and serum SIRT1; Logistic regression analysis was applied to analyze the prognostic factors of pa-tients with upper gastrointestinal hemorrhage due to cirrhosis; ROC curve was applied to analyze the evaluation value of serum FOXM1and SIRT1 levels for the prognosis and death of patients.Results The expression level of FOXM1 (0.96±0.10, 1.07±0.21, 2.36±0.45,3.26±0.78) in serum of patients with upper gastrointestinal hemorrhage due to cirrhosis increased gradually (P<0.05), the expressionlevel of SIRT1 [(2 542.65±258.68) ng/L, (2 163.84±184.76) ng/L, (1 658.72±148.53) ng/L, (968.41±126.81) ng/L] decreased gradually (P<0.05). Compared with the survival group, the expression level of serum SIRT1 in the death group was obviously lower (P<0.05), theexpression level of FOXM1, prothrombin time, hemoglobin, and proportion of liver function grade C were obviously higher (P<0.05).There was a obvious negative correlation between serum FOXM1 level and serum SIRT1 level in patients with upper gastrointestinalhemorrhage due to cirrhosis (r=.0.61, P<0.001). FOXM1, prothrombin time, hemoglobin, and liver function Child grade C were risk fac-tors for the prognosis and death of patients with upper gastrointestinal hemorrhage due to cirrhosis, while SIRT1 was a protective factor(P<0.05). The AUC of the combination of FOXM1 and SIRT1 in predicting the prognosis of patients was 0.99, the sensitivity was94.74%, and the specificity was 93.12%, which was better than the independent prediction (Zcombined detection-FOXM1=2.42, Zcombined detection-SIRT1 = 2.14, P=0.016, 0.032).Conclusions The levels of serum FOXM1 and SIRT1 are closely related to the severity and prognosis of pa-tients with upper gastrointestinal hemorrhage due to cirrhosis. The combination of the two has a good reference value for the prognosisprediction of patients with upper gastrointestinal hemorrhage due to cirrhosis. |
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