摘要
目的探讨Fcγ受体IIA(FcγRIIA)、亚甲基四氢叶酸还原酶(MTHFR)基因多态性与急性髓系白血病(AML)患儿化疗后血流感染的关联。方法回顾性分析武汉儿童医院血液肿瘤科2010年2月-2021年11月130例初诊初治AML患儿接受首次诱导化疗的临床资料;首次诱导化疗后发生血流感染患儿62例纳入感染组,未发生血流感染患儿68例为对照组。采用聚合酶链式反应(PCR)技术-限制性片段长度多态性法(RFLP)对两组患儿外周血FcγRIIA、MTHFR进行基因分型。结果血流感染患儿血培养标本共培养分离病原菌78株,其中革兰阴性菌44株占56.41%,以大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌21株(26.92%),以表皮葡萄球菌为主;真菌13株,以白假丝酵母为主;多元Logistic回归分析显示,血小板计数及中性粒细胞是AML患儿化疗后血流感染的危险因素(P<0.05);感染组FcγRIIA基因R131位点携带G/G基因型及G等位基因频率均高于未感染组(P<0.05),感染组MTHFR基因C677T位点携带T/T基因型及T等位基因频率均高于未感染组(P<0.05);校正Logistic回归分析显示,FcγRIIA基因R131位点携带G等位基因的AML患儿化疗后发生血流感染风险是携带A等位基因的1.697倍(校正OR=1.697,95%CI:1.181~2.439);MTHFR基因C677T位点上携带T等位基因的AML患儿化疗后血流感染风险是携带C等位基因的1.659倍(校正OR=1.659,95%CI:1.239~2.221)。结论AML患儿化疗后血流感染病原菌以大肠埃希菌、肺炎克雷伯菌等革兰阴性菌为主,FcγRIIA基因R131位点携带G等位基因、MTHFR基因C677T位点上携带T等位基因的AML患儿化疗后血流感染发生风险明显增加。
OBJECTIVE To investigate the association of Fc receptor IIA(FcγRIIA)and methylenetetrahydrofolate reductase(MTHFR)gene polymorphisms with bloodstream infection after chemotherapy in children with a-cute myeloid leukemia(AML).METHODS The clinical data of 130 children with newly-diagnosed and treated AML who received first induction chemotherapy in department of hematology and oncology of Wuhan Children's Hospital from Feb.2010 to Nov.2021 were retrospectively analyzed.62 children with bloodstream infection after first induction chemotherapy were included in the infection group,and 68 children without bloodstream infection were included in the uninfected group.Polymerase chain reaction(PCR)-restriction fragment length polymorphism(RFLP)was used to genotype the FcRIA and MTHFR in peripheral blood of the two groups of children.RESULTS Totally 78 strains of pathogenic bacteria were isolated from blood culture specimens among children with bloodstream infection,of which 44 strains of gram-negative bacteria accounted for 56.41%,mainly Escherichia coli and Klebsiella pneumoniae,21 strains of gram-positive bacteria accounted for 26.92%,mainly Staphylococcus epidermidis,and 13 strains of fungi accounted for 16.67%,mainly Candida albicans.Multivariate logistic regression analysis showed that platelet count and neutrophil were the risk factors of bloodstream infection in children with AML after chemotherapy(P<o.05).The proportions of G/G genotype and G allele frequency at R131 locus of FcγRIIA gene were higher in infected group than those in uninfected group(P<0.05).The proportions of T/T genotype and T allele frequency at C677T locus of MTHFR gene in infected group were also higher than those in uninfected group(P<0.05).Corrected Logistic regression analysis showed that the risk of bloodstream infection in children with AML who carried G allele at R131 locus of FcγRIIA gene was 1.697 times higher than that of children carrying A allele after chemotherapy(corrected OR=1.697,95%CI:1.181-2.439).The risk of bloodstream infec
作者
杜宇
熊昊
杨李
陈智
陶芳
孙鸣
卢文婕
付强
祁闪闪
龙飞
DU Yu;XIONG Hao;YANG Li;CHEN Zhi;TAO Fang;SUN Ming;LU Wen-jie;FU Qiang;QI Shan-shan;LONG Fei(Wuhan Children's Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430016,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第19期3018-3023,共6页
Chinese Journal of Nosocomiology
基金
湖北省自然科学基金青年基金资助项目(2020CFB364)。
