口腔颌面部间隙感染患者引流液中p38和MK2蛋白表达及基因水平与创面愈合的关系

Relationship between the expression of p38 and MK2 proteins and gene levels in drainage fluid of patients with oral and maxillofacial space infection and wound healing

目的分析口腔颌面部间隙感染(MSI)患者引流液中p38、丝裂原活化蛋白激酶2(MK2)蛋白表达和mRNA水平与创面愈合的关系。方法选取2015年7月-2020年7月南京医科大学附属口腔医院收治的102例MSI患者,根据引流术后8 d创面愈合情况,将其分为创面愈合良好组(n=57)和创面愈合不良组(n=45)。所有患者均采用负压封闭引流联合抗菌药物冲洗治疗,连续治疗7 d。分别于治疗前和治疗7 d后,检测白细胞(WBC)、血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)和降钙素原(PCT)水平。分别于置管即刻和拔管即刻,采用Western blot和荧光定量聚合酶链式反应(PCR)检测p38、MK2蛋白表达和mRNA水平。采用Pearson相关性分析p38和MK2的磷酸化水平与血清炎症因子间的关系。结果创面愈合良好组和创面愈合不良组患者治疗后的WBC、TNF-α、IL-6、CRP、PCT均低于治疗前(P<0.001),拔管即刻p-p38/p38、p-MK2/MK2蛋白表达和p38、MK2 mRNA水平均低于置管即刻(P<0.001);治疗后,创面愈合良好组患者WBC、TNF-α、IL-6、CRP、PCT均低于创面愈合不良组(P<0.05),拔管即刻,创面愈合良好组患者p-p38/p38、p-MK2/MK2蛋白表达和p38、MK2 mRNA水平均明显低于创面愈合不良组(P<0.001);Pearson相关性分析显示,拔管即刻引流液中p-p38/p38和p-MK2/MK2均与治疗后WBC、TNF-α、IL-6、CRP、PCT呈正相关(P<0.001)。结论MSI患者引流液中p38和MK2的磷酸化可促进血清炎症因子的释放,影响创面愈合。

OBJECTIVE To analyze the relationship between the expression ofp38 and mitogen-activated protein kinase 2(MK2)proteins and mRNA levels in drainage fluid of patients with oral and maxillofacial space infection(MSI)and wound healing.METHODS A total of 102 MSI patients admitted to Stomatological Hospital Affiliated to Nanjing Medical University from Jul.2015 to Jul.2020 were selected,and divided into good wound healing group(n=57)and poor wound healing group(n=45)according to their wound healing at 8 d after drainage.All were treated with vacuum sealing drainage(VSD)and antibacterial washing for 7 d.Before treatment and at 7 d after treatment,levels of white blood cells(WBC),serum tumor necrosis factorα(TNF-α),interleukin 6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)were detected.Immediately after intubation and extubation,expression of p38 and MK2 proteins,and mRNA levels were detected by Western blot and fluorescence quantitative polymerase chain reaction(PCR).The relationship between phosphorylation levels of p38 and MK2 and serum inflammatory factors was analyzed by Pearson correlation analysis.RESULTS After treatment,levels of WBC,TNF-α,IL-6,CRP and PCT in the good wound healing group were significantly lower than those before treatment(P<0.001),and the expression of p38 and MK2 proteins,and mRNA levels immediately after extubation were significantly lower than those immediately after intubation(P<0.001).After treatment,levels of WBC,TNF-α,IL-6,CRP and PCT in good wound healing group were significantly lower than those in poor wound healing group(P<0.001),and expression of p38 and MK2 proteins,and mRNA levels in good wound healing group immediately after extubation were significantly lower than those in poor wound healing group(P<0.001).Pearson correlation analysis showed that p-p38/p38 and p-MK2/MK2 in drainage fluid immediately after extubation were positively correlated with WBC,TNF-α,IL-6,CRP and PCT after treatment(P<0.05).CONCLUSION The phosphorylation of p38 and MK2 in drainage fluid of MSI patients can promote the release of serum inflammatory factors and affect wound healing.