糖尿病足感染患者炎症因子和Toll样受体信号通路的表达及意义

Expression of inflammatory factors and Toll-like receptors signaling pathways in diabetic foot infection patients and their significance

目的探讨糖尿病足感染患者炎症因子和Toll样受体(toll-like receptors,TLRs)信号通路表达的变化及其与感染的相关性,旨在为预防和诊断糖尿病足感染提供相关依据。方法选取2016年12月-2018年12月哈励逊国际和平医院收治的173例糖尿病足患者为研究对象,并根据患者是否并发感染分为感染组(84例)和非感染组(89例),选取同期健康体检者79名为对照组,分析感染患者病原菌检出情况,比较分析3组研究对象炎症因子血清超敏C-反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、降钙素原(Procalcitonin,PCT)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)及外周血单核细胞TLR2、TLR4水平变化情况,并分析各指标与感染严重程度的相关性。结果 84例感染患者共分离102株病原菌,其中革兰阴性菌61株(59.80%)、革兰阳性菌39株(38.24%)、真菌2株(1.96%)。感染组患者炎症因子hs-CRP、PCT、TNF-α、IL-6水平分别为(11.24±5.58)mg/L、(5.13±2.25)mg/L、(22.18±5.59)ng/L、(21.98±4.79)ng/L水平均高于未感染组和对照组(P<0.05);外周血单核细胞TLR2(61.25±11.38)%、TLR4(59.93±10.27)%水平均高于未感染组和对照组(P<0.05);且随着患者感染严重程度增加,各指标水平也有所上升(P<0.05)。相关性分析结果显示,血清hs-CRP、PCT、TNF-α、IL-6及外周血单核细胞TLR2、TLR4水平均与感染严重程度呈正相关关系(P<0.05)。结论感染性糖尿病足患者以革兰阴性菌感染为主,而血清hs-CRP、PCT、TNF-α、IL-6水平及外周血单核细胞TLR2、TLR4水平与糖尿病足感染的发生发展相关。

OBJECTIVE To explore the expression of inflammatory factors and Toll-like receptors(TLRs) signaling pathways in patients with diabetic foot infection and analyze their association with the infection so as to provide guidance for prevention and diagnosis of diabetic foot infection. METHODS A total of 173 diabetic foot patients who were treated in Harrison International Peace Hospital from Dec 2016 to Dec 2018 were recruited as the study objects and divided into the infection group with 84 cases and the non-infection group with 89 cases according to the status of infection, meanwhile, 79 healthy people who received physical examination were chosen as the control group, the distribution of isolated pathogens was observed, the levels of serum inflammatory factors high-sensitivity C-reactive protein(hs-CRP), procalcitonin(PCT), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6), as well as peripheral blood mononuclear cells TLR2 and TLR4 were observed and compared among the three groups of study objects, and the correlation between the indexes and the severity of infection was analyzed. RESULTS Totally 102 strains of pathogens were isolated from the 84 patients with infection, 61(59.80%) of which were gram-negative bacteria, 39(38.24%) were gram-positive bacteria, and 2(1.96%) were fungi.The levels of inflammatory factors hs-CRP, PCT, TNF-α and IL-6 of the infection group were respectively(11.24±5.58)mg/L,(5.13±2.25)mg/L,(22.18±5.59)ng/L and(21.98±4.79)ng/L, significantly higher than those of the non-infection group and the control group(P<0.05).The levels of peripheral blood mononuclear cells TLR2 and TLR4 of the infection group were respectively(61.25±11.38)% and(59.93±10.27)%, significantly higher than those of the non-infection group and the control group(P<0.05);the levels of the indexes were significantly elevated with the severity of infection(P<0.05).The result of correlation analysis showed that the levels of serum hs-CRP, PCT, TNF-α and IL-6 as well as the peripheral blood mononuclear cells TLR2 and TLR4 were positively correlated with the severity of infection(P<0.05). CONCLUSION The patient with gram-negative bacteria infection are dominant among the patients with diabetic foot infection.The levels of serum hs-CRP, PCT, TNF-α and IL-6 as well as the peripheral blood mononuclear cells TLR2 and TLR4 are closely associated with the occurrence and development of diabetic foot infection.