溴结构域蛋白4在主动脉夹层患者循环炎症细胞中的表达差异及临床意义

Differential expression and clinical significance of bromodomain-containing protein 4 in circulating inflammatory cells of patients with aortic dissection

摘要:

目的]探讨主动脉夹层患者外周血循环炎症细胞中溴结构域蛋白4(BRD4)的表达水平,通过ROC曲线分析验证其临床应用价值。 [方法]选取38例主动脉夹层患者与38例健康体检者的全血标本,采用流式细胞术检测循环炎症细胞中BRD4高表达的细胞亚群,比较两组之间的表达差异,并构建多变量联合诊断模型评估其诊断效能。 [结果]与健康体检者相比,主动脉夹层患者中循环BRD4高表达白细胞比例显著升高(P＜0.05),其中中间型单核细胞、中性粒细胞中高表达BRD4的比例显著升高(P＜0.05)。基于上述细胞亚群构建联合诊断模型,该模型最佳临界值为0.644 4,灵敏度为75.68%,特异度为94.59%,AUC为0.919 6(95%CI:0.863 4～0.947 4)。[结论]主动脉夹层患者循环中中性粒细胞与中间型单核细胞的BRD4高表达比例显著升高,基于多种免疫细胞亚群BRD4表达构建的联合模型对主动脉夹层与健康对照具有较好的区分能力,BRD4高表达免疫细胞比例有望作为主动脉夹层辅助识别的潜在循环生物标志物。

Abstract:

Aim To investigate the expression level of bromodomain-containing protein 4 (BRD4) in peripheral blood circulating inflammatory cells of patients with aortic dissection, and verify its clinical application value through ROC curve analysis. Methods Whole blood samples from 38 patients with aortic dissection and 38 healthy subjects were selected, and flow cytometry was used to detect the subsets of BRD4-highly expressing cells in circulating inflammatory cells. The expression differences between the two groups were compared, and a multivariate combined diagnostic model was constructed to evaluate its diagnostic efficacy. Results Compared with healthy subjects, the proportion of BRD4-highly expressing leukocytes was significantly increased in patients with aortic dissection (P＜0.05). Among them, the percentages of BRD4-highly expressing intermediate monocytes and neutrophils were both markedly elevated (P＜0.05). Based on the above cell subsets, the combined diagnostic model achieved an optimal cut-off value of 0.644 4, with a sensitivity of 75.68%, a specificity of 94.59%, and an AUC of 0.919 6 (95%CI:0.863 4~0.947 4). Conclusions The proportion of BRD4-highly expressing neutrophils and intermediate monocytes was significantly increased in the circulation of patients with aortic dissection. The combined model based on BRD4 expression across multiple immune-cell subsets showed good discrimination between patients with aortic dissection and healthy controls, suggesting that the proportion of BRD4-highly expressing immune cells may serve as a potential circulating biomarker for auxiliary identification of aortic dissection.