肿瘤坏死因子α-308基因多态性与中心静脉导管相关脓毒症易感性与感染程度的关系

Relationship of TNF-oL-308 gene polymorphism with susceptibifity and severity of central venous catheter-related sepsis

目的探讨肿瘤坏死因子α基因启动子308位点（TNF-α-308）多态性与中心静脉导管相关脓毒症（CRS）的易感性和严重程度的关系。方法选取自2015年1月至2017年5月开化县人民医院收治的105例CRS患者（CRS组），根据是否并发多器官功能障碍综合征（MODS）分为CRS并发MODS组（34例）和CRS非MODS组（71例）。同时选取同期210例导管无相关感染患者（病例对照组）和105例健康体检者（健康对照组）为研究对象，应用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）对TNF-α-308进行基因分型，分析TNF-α-308基因多态性与CRS易感性和严重程度的关系。采用SPSS 16.0软件对数据进行分析。结果CRS组、病例对照组和健康对照组三组间的TNF-α-308位点GG、GA、AA基因型频率和G、A等位基因频率比较，差异均无统计学意义（χ^2=2.262和0.907，P值均〉0.05）。CRS并发MODS组TNF-α-308位点基因型频率与CRS非MODS组、病例对照组、健康对照组相比，GG基因型频率明显降低，GA、AA基因型频率明显升高（χ^2=8.809、7.700和9.220，P值均〈0.05）。CRS并发MODS组TNF-α-308位点等位基因频率与CRS非MODS组、病例对照组、健康对照组相比，G等位基因频率明显降低，A等位基因频率明显升高（χ2=9.823、8.624和7.654，P值均〈0.05）。CRS非MODS组的TNF-α-308位点基因型频率（χ^2=0.852和0.975，P值均〉0.05）和等位基因频率（χ^2=1.022和0.535，P值均〉0.05）与病例对照组、健康对照组相比，差异均无统计学意义。CRS并发MODS组TNF-α-308的GA＋AA基因型比值比为2.664（95%CI 1.259～5.639）；A等位基因比值比为2.440（95%CI 1.326～4.490）。结论TNF-α-308位点基因多态性不是CRS的易感因素，但与CRS并发MODS相关。

Objective To investigate the relationship of TNF-α gene promoter 308 locus （TNF-α-308） polymorphism with the susceptibility and severity of central venous catheter-related sepsis （CRS）.Methods One hundred and five CRS patients admitted in Kaihua People’s Hospital from January 2015 to May 2017 were enrolled in the study. According to whether complicated with multiple organ dysfunction syndrome （MODS）, they were divided into CRS complicated MODS group （n=34） and CRS non-MODS group （n=71）. Meanwhile, 210 patients with no catheter-related infection （case control group） and 105 healthy subjects （healthy control group） were also enrolled in the study. Polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） was used to genotype TNF-α-308, and the relationship of TNF-α-308 polymorphism with the susceptibility and severity of CRS was investigated. SPSS 16.0 was used to analyze the data.Results There were no significant differences in frequencies of GG, GA, AA genotypes and G, A allele of TNF-α-308 among CRS group, case control group and healthy control group （χ^2=2.262 and 0.907, both P〉0.05）. Compared with CRS non-MODS group, case control group and healthy control group, the frequency of GG genotype was significantly lower and the frequencies of genotype GA and AA of TNF-α-308 were significantly higher in CRS MODS group （χ^2=8.809, 7.700 and 9.220, all P〈0.05）. Compared with CRS non-MODS group, case control group and healthy control group, the allele frequencies of G were significantly lower and allele frequency of A allele of TNF-α-308 was significantly higher in CRS MODS group （χ2=9.823, 8.624 and 7.654, all P〈0.05）. There were no significant differences in genotype frequency and allele frequencies of TNF-α-308 （χ^2=0.852 and 0.975, both P〉0.05） among CRS non-MODS group and case control group, healthy control group （χ^2=1.022 and 0.535, both P〉0.05）. The odds ratio of GA＋ AA genotype and A allele of TNF-α-308 in CRS MODS group were 2.664 （95%CI 1.259-5.639） and 2.440 （95%CI 1.326-4.490）.Conclusion TNF-α gene promoter 308 locus polymorphism is not a predisposing factor for CRS, but may be associated with complication of MODS in CRS patients.