腹主动脉瘤腔内修复术后感染病原菌及Hippo信号通路基因改变

Pathogens isolated from endovascular aneurysm repair patients with postoperative infection and changes of Hippo signaling pathway genes

目的探讨腹主动脉瘤腔内修复术(EVAR)后医院感染病原特点及Hippo信号通路基因、白细胞介素-17(Interleukin-17,IL-17)、IL-23改变。方法选择天津医院血管外科2017年5月-2020年3月收治腹主动脉瘤EVAR术后医院感染患者49例作为感染组,选择同期医院进行EVAR术后未发生医院感染患者60例作为非感染组。采用实时荧光定量逆转录聚合酶链反应(RT-PCR)法检测Hippo通路基因yap、taz、mst1相对表达水平,采用酶联免疫吸附法检测其辅助型T细胞17(Th17)促炎细胞因子白细胞介素-17(IL-17)、IL-23水平。结果49例患者共发生肺部感染33例(67.35%),尿路感染10例(20.41%),手术切口感染4例(8.16%),移植物感染2例(4.08%);感染病原以革兰阳性菌为主,共25株,占51.02%,革兰阴性菌共22株,占44.90%,真菌2株,占4.08%;感染组yap、taz、mst1基因相对表达水平和IL-17、IL-23水平高于非感染组(P<0.05)。结论腹主动脉瘤EVAR术后医院感染以肺部感染、尿路感染为主,应及时予以针对性预防;Hippo通路参与了感染发生过程,通过Th17促炎途径诱导炎症反应,其机制仍有待研究。

OBJECTIVE To explore the etiological characteristics of postoperative nosocomial infection in patients undergoing endovascular aneurysm repair(EVAR)and observe the changes of Hippo signaling pathway genes,interleukin-17(IL-17)and IL-23.METHODS Totally 49patients with abdominal aortic aneurysm who underwent EVAR in vascular surgery department of Tianjin Hospital from May 2017to Mar 2020were assigned as the infection,meanwhile,60patients who did not have nosocomial infection after EVAR were set as the non-infection group.The relative expression levels of Hippo signaling pathway genes yap,taz and mst1were detected by using real-time fluorescent quantitative reverse transcription PCR(RT-PCR),and the levels of helper T cell 17(Th17)and pro-inflammatory cytokines interleukin-17(IL-17)and IL-23were detected by means of enzyme-linked immunosorbent assay(ELISA).RESULTS Of the 49patients with postoperative nosocomial infection,33(67.35%)had pulmonary infection,10(20.41%)had urinary tract infection,4(8.16%)had surgical incision infection,and 2(4.08%)had graft infection.Among the pathogens isolated from the patients with infection,there were 25(51.02%)strains of gram-positive bacteria,22(44.90%)strains of gram-negative bacteria and 2(4.08%)strains of fungi.The relative expression levels of yap,taz,mst1and levels of IL-17and IL-23of the infection group were significantly higher than those of the non-infection group(P<0.05).CONCLUSIONThe patients with pulmonary infection and urinary tract infection are dominant among the EVAR patients with postoperative nosocomial infection.It is necessary to take targeted prevention measures in a timely manner.Hippo pathway participates in the process of infection and induces inflammatory response through the Th17pro-inflammatory pathway,and its mechanism remains to be studied.