摘要
目的探讨肿瘤坏死因子-α(TNF-α)G308A基因多态性与心脏手术术后切口感染的关联。方法选取2015年1月-2022年1月武汉市普仁医院收治的心脏手术患者600例为研究对象,根据术后是否发生切口感染分为感染组60例、未感染组540例;分析术后切口感染危险因素、病原菌分布情况及TNF-αG308A基因多态性。结果60例术后切口感染患者共分离出86株病原菌,其中革兰阴性菌45株、革兰阳性菌26株、真菌15株。两组患者切口长度、手术时间、术中出血量、预防性使用抗菌药物、白细胞介素(IL)-6、IL-10、TNF-α、降钙素原(PCT)水平存在差异(P<0.05)。两组患者TNF-αG308A基因型频率分布差异有统计学意义,且感染组患者GG基因型频率高于非感染组(P<0.05)。Logistic分析结果显示,切口长度、手术时间、术中出血量、是否预防性使用抗菌药物以及TNF-αG308A基因型均为术后切口感染的危险因素(P<0.05)。IL-6、IL-10、PCT、TNF-α水平以及TNF-αG308A基因型曲线下面积(AUC)分别为0.760、0.773、0.735、0.836、0.892,差异具有统计学意义(P<0.05)。结论切口长度、手术时间、术中出血量、是否预防性使用抗菌药物、炎症反应以及TNF-αG308A基因型均为术后切口感染的危险因素,术后切口感染病原菌以革兰阴性菌为主。
OBJECTIVE To explore the association of postoperative incision infection in cardiac surgery patients with tumor necrosis factor-α(TNF-α)G308A gene polymorphism.METHODS A total of 600 patients who underwent cardiac surgery in Wuhan Puren Hospital from Jan 2015 to Jan 2022 were recruited as the study subjects and divided into the infection group with 60 cases and the no infection group with 540 cases according to the status of postoperative incision infection.The risk factors for the postoperative incision infection,distribution of pathogens and TNF-αG308A gene polymorphisms were observed.RESULTS Totally 86 strains of pathogens were isolated from the 60 patients with postoperative incision infection,45 of which were gram-negative bacteria,26 were gram-positive bacteria,and 15 were fungi.There were significant differences in length of incision,operation duration,intraoperative blood loss volume,prophylactic use of antibiotics,interleukin(IL)-6,IL-10,TNF-αand procalcitonin(PCT)between the two groups of patients(P<0.05).There were significant differences in the frequencies of genotypes of TNF-αG308A between the two groups of patients,and the frequency of GG genotype of the infection group was higher than that of the no infection group(P<0.05).The result of logistic analysis showed that the length of incision,operation duration,intraoperative blood loss volume,prophylactic use of antibiotics and TNF-αG308A genotype were the risk factors for the postoperative incision infection(P<0.05).The areas under curves(AUCs)of IL-6,IL-10,PCT,TNF-αand TNF-αG308A genotype were 0.760,0.773,0.735,0.836 and 0.892,respectively,and there were significant differences(P<0.05).CONCLUSION The length of incision,operation duration,intraoperative blood loss volume,prophylactic use of antibiotics,inflammatory reaction and TNF-αG308A genotype are the risk factors for the postoperative incision infection.The gram-negative bacteria are dominant among the pathogens isolated from the patients with postoperative incision infection.
作者
王杰
徐祥
苏甜
郭宁
WANG Jie;XU Xiang;SU Tian;GUO Ning(Wuhan Puren Hospital,Wuhan,Hubei 43008l,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第22期3424-3428,共5页
Chinese Journal of Nosocomiology
基金
湖北省卫生健康委科学研究基金资助项目(WJ2021N030)。
