胃肠术后PICC相关性感染影响因素及HMGB-1水平

Influencing factors ofr PICC-related infection after gastrointestinal surgery and HMGB-1 level

目的探讨胃肠外科术后中心静脉导管(PICC)相关性感染患者血清淀粉样蛋白A(SAA)、白细胞介素-18(IL-18)、高迁移率族蛋白1(HMGB-1)及其影响因素与疗效情况。方法选取2019年2月-2020年2月海南省第三人民医院胃肠外科术后PICC感染患者106例设为研究组,另选取同期未发生感染的患者106例设为对照组。比较两组及不同感染情况患者以及不同感染控制情况患者血清SAA、IL-18、HMGB-1水平,并分析上述血清指标与急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭估计(SOFA)评分关联性及对胃肠外科术后PICC感染的预测价值。结果研究组血清SAA、IL-18、HMGB-1水平、APACHEⅡ、SOFA评分分别为(261.90±21.25)mg/L、(240.71±49.21)ng/L、(17.24±5.13)μg/L、(16.71±3.06)分、(10.96±1.37)分高于对照组(P<0.001);血清SAA、IL-18、HMGB-1水平与APACHEⅡ、SOFA评分呈正相关(P<0.05);SAA、IL-18、HMGB-1水平是胃肠外科术后PICC感染发生的影响因素(P<0.001);SAA、IL-18、HMGB-1联合预测胃肠外科术后PICC感染发生的曲线下面积(AUC)为0.897,敏感度为79.25%,特异度为91.51%;血行感染患者血清SAA、IL-18、HMGB-1水平分别为(382.60±31.40)mg/L、(317.69±50.10)ng/L、(28.81±5.45)μg/L高于局部感染患者(P<0.001);感染控制者血清SAA、IL-18、HMGB-1分别为(96.37±15.26)mg/L、(196.73±46.34)ng/L、(5.01±2.98)μg/L低于未控制者(P<0.001)。结论血清SAA、IL-18、HMGB-1高表达是胃肠外科术后PICC感染的影响因素,并与病情程度存在正相关性,三者联合可为临床诊治、病情程度评估、疗效判断提供新方向。

OBJECTIVE To investigate the correlation between serum amyloid A(SAA), interleukin 18(IL-18), high mobility group box 1(HMGB-1) levels in patients with peripherally inserted central catheter(PICC) infection after gastrointestinal surgery and their influencing factors and curative effect. METHODS From Feb. 2019 to Feb. 2020, 106 patients with peripherally inserted central catheter(PICC) infection after gastrointestinal surgery in Hainan Third People′s Hospital were selected as the study group, and 106 patients without infection during the same period were selected as the control group. The serum SAA, IL-18, and HMGB-1 levels of patients with different infection conditions and patients with different infection control conditions in the two groups were compared. The correlation between the above-mentioned serum indexes and the Acute Physiology and Chronic Health Score Ⅱ(APACHE Ⅱ), Sequential Organ Failure Assessment(SOFA) scores, and the predictive value of PICC infection after gastrointestinal surgery were analyzed. RESULTS The serum SAA, IL-18, HMGB-1, APACHEⅡ and SOFA scores levels of the study group were(261.90±21.25) mg/L,(240.71±49.21) ng/L,(17.24±5.13) μg/L,(16.71±3.06), and(10.96±1.37) points, respectively, significantly higher than those in the control group(P<0.001). Serum SAA, IL-18, HMGB-1 levels were positively correlated with APACHEⅡ and SOFA scores(P<0.001). SAA, IL-18 and HMGB-1 levels were the influencing factors of PICC infection after gastrointestinal surgery(P<0.001). The area under the curve(AUC) of SAA, IL-18, and HMGB-1 combined to predict the occurrence of PICC infection after gastrointestinal surgery was 0.897, the sensitivity was 79.25%, and the specificity was 91.51%. The levels of serum SAA, IL-18, and HMGB-1 in patients with blood infection were(382.60±31.40) mg/L,(317.69±50.10) ng/L, and(28.81±5.45) μg/L, respectively, significantly higher than those in patients with local infection(P<0.001). The levels of serum SAA, IL-18, and HMGB-1 in infection-controllers were(96.37±15.26) mg/L,(196.73±46.34) ng/L, and(5.01±2.98) μg/L, respectively, significantly lower than those of uncontrolled patients(P<0.001). CONCLUSION The high expression of serum SAA, IL-18, HMGB-1 were the influencing factors of PICC infection after gastrointestinal surgery, and there was a positive correlation with the severity of the disease. The combination of the three can provide a new direction for clinical diagnosis and treatment, evaluation of disease severity, and efficacy judgment.