摘要
目的探讨根治性膀胱切除术(RC)后尿路感染的病原学特征及外周血对Toll样受体(TLR)4/核因子(NF)-κB信号通路分析。方法回顾性分析2019年1月-2022年12月于河北医科大学第四医院行RC治疗的104例患者一般临床资料,根据是否出现尿路感染分为感染组(n=32)与未感染组(n=72),比较两组外周血TLR4/NF-κB信号通路指标,并采用受试者工作特征(ROC)曲线探究其对RC术后尿路感染的诊断价值。结果32例感染患者共检出58株病原菌,其中革兰阴性菌株占60.34%,主要病原菌为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌;革兰阳性菌株占32.76%,主要病原菌为粪肠球菌、表皮葡萄球菌、屎肠球菌;真菌占6.90%;感染组血尿素氮(BUN)、血肌酐(Scr)高于未感染组,内生肌酐清除率(Ccr)低于未感染组(P<0.05);感染组TLR4 mRNA、NF-κB mRNA高于未感染组(P<0.05);感染组CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)低于未感染组,白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及CD_(8)^(+)高于未感染组(P<0.05);ROC特征曲线结果显示,TLR4 mRNA联合NF-κB mRNA诊断RC术后尿路感染的AUC及特异性均高于单一指标诊断(P<0.05)。结论革兰阴性菌为RC术后尿路感染主要致病菌,且感染后患者肾功能及免疫功能均受损,TLR4/NF-κB信号通路指标均呈升高趋势,推测可能与TLR4/NF-κB信号通路介导炎性反应有关,且TLR4 mRNA联合NF-κB mRNA对RC术后尿路感染具有一定的临床诊断价值,建议予以密切监测。
OBJECTIVE To investigate the etiological characteristics of urinary tract infection in patients after radical cystectomy(RC), and to analyze the changes of peripheral blood Toll-like receptor(TLR) 4/nuclear factor(NF)-κB signal pathway. METHODS The general clinical data of 104 patients who underwent RC in the Fourth Hospital of Hebei Medical University between Jan 2019 and Dec 2022 were analyzed retrospectively. According to whether urinary tract infection occurred, the patients were divided into the infected group(n=32) and uninfected group(n=72). Variation levels of TLR4/NF-κB signal pathway associated indicators in peripheral blood were compared between the two groups. The diagnostic value of these indicators for urinary tract infections after RC was analyzed using the receiver operating characteristic(ROC) curve. RESULTS A total of 58 pathogenic bacteria strains were detected in the infected group, of which gram-negative bacteria accounted for 60.34%. The main pathogenic bacteria included Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae. Gram-positive bacteria accounted for 32.76%. The main pathogenic bacteria included Enterococcus faecalis, Staphylococcus epidermidis and Enterococcus faecium. Fungi accounted for 6.90%. Levels of blood urea nitrogen(BUN) and serum creatinine(Scr) in the infected group were significantly higher than those in the uninfected group, while the endogenous creatinine clearance rate(Ccr) was lower than that in the uninfected group(P<0.05). The levels of TLR4 mRNA, NF-κB mRNA, interleukin-6(IL-6) and tumor necrosis factor(TNF-α) in the infected group were higher than those in the uninfected group(P<0.05). CD_(3)^(+), CD_(4)^(+) and CD_(4)^(+)/CD_(8)^(+) in the infected group were significantly lower than those in the uninfected group. Interleukin-6(IL-6), tumor necrosis factor(TNF)-α and CD_(8)^(+) were higher than those in the uninfected group(P<0.05). ROC curve analysis showed that the AUC and specificity of the combined detection of TLR4 mRNA and NF-κB mRNA fo
作者
金婷婷
李云娇
高凤蕊
史翠娜
JIN Ting-ting;LI Yun-jiao;GAO Feng-rui;SHI Cui-na(The Fourth Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第24期3753-3757,共5页
Chinese Journal of Nosocomiology
基金
河北省卫生健康委医学研究课题(20221299)。
