外周血TLR5基因C1174T位点多态性与剖宫产后导管相关尿路感染的关联

Correlation between peripheral blood TLR5 gene C1174T polymorphism and catheter-related urinary tract infection after cesarean section

目的 探讨外周血Toll样受体5(TLR5)基因C1174T位点多态性对剖宫产后导管相关尿路感染(CAUTI)的影响。方法 选择江阴市中医院妇产科2018年8月-2021年3月在剖宫产术后发生CAUTI产妇78例为CAUTI组,选择同期78例剖宫产术后留置导尿管但未发生CAUTI产妇为非CAUTI组。产妇均在产后留取尿液接种于培养皿进行培养,对病原菌种进行分析鉴定。入院时抽取所有产妇外周肘静脉血,采用聚合酶链式扩增反应(PCR)对目的片段进行扩增,采用酶联免疫吸附法检测血清中TLR5水平。结果 CAUTI组留置导尿管时间长于非CAUTI组,瘢痕子宫、妊娠期糖尿病、尿插管次数≥2次者多于非CAUTI组(P<0.05);78例CAUTI患者共检出病原菌78株,其中革兰阴性菌52株占66.67%,革兰阳性菌26株占33.33%,大肠埃希菌检出率最高,共33株占42.31%;CAUTI组TLR5基因C1174T位点AA基因型、A等位基因频率高于非CAUTI组(P<0.05);多元Logistic回归分析结果显示,导尿管留置时间、妊娠期糖尿病、尿管插管次数和TLR5基因C1174T位点多态性均为剖宫产术后发生CAUTI的影响因素(P<0.05);CAUTI组TLR5基因C1174T位点携带AA型、GA型和GG型患者血清TLR5水平整体比较差异具有统计学意义(P<0.05),其中AA型高于GA型和GG型(P<0.05)。结论 TLR5基因C1174T位点基因型突变可能是导致剖宫产术后CAUTI的影响因素,其机制还需进一步研究。

OBJECTIVE To explore the effect of the C1174 T polymorphism of the Toll like receptor 5(TLR5) gene in peripheral blood on catheter-related urinary tract infection(CAUTI) after cesarean section. METHODS A total of 78 women with CAUTI after cesarean section in the department of obstetrics and gynecology of Jiangyin hospital of traditional chinese medicine from Aug 2018 to Mar 2021 were recruited as the CAUTI group, and 78 women with indwelling catheters but without CAUTI after cesarean section during the same period were in the un-CAUTI group. Puerperal urine was collected cultured in in petri dishes to detect pathogens. Peripheral cubital venous blood drawn from all puerperae on admission was used to detect the target gene by polymerase chain amplification reaction(PCR) assay. And the level of TLR5 was detected by enzyme-linked immunosorbent assay. RESULTS The catheterization time in the CAUTI group was significantly longer than that in the non-CAUTI group;the number of patients with scarred uterus, gestational diabetes and times of urinary intubation ≥2 in the CAUTI group were significantly larger than those in the non-CAUTI group(P<0.05). 78 strains of pathogenic bacteria were detected in 78 CAUTI patients, of which 52 strains were Gram-negative bacteria, accounting for 66.67%, and 26 strains were Gram-positive bacteria, accounting for 33.33 %. The detection rate of Escherichia coli was the highest, and 33 strains accounted for 42.31%. The frequency of AA genotype and A allele at C1174 T locus of TLR5 gene in the CAUTI group was significantly higher than that in the non-CAUTI group(P<0.05). Multivariate Logistics regression analysis showed that catheter indwelling time, gestational diabetes, urinary catheterization times and the C1174 T polymorphism of the TLR5 gene are independent risk factors for CAUTI after cesarean section(P<0.05). The overall difference in the serum TLR5 level among patients carrying AA, GA and GG genotypes at TLR5 gene C1174 locus in the CAUTI group was significant(P<0.05);and serum TLR5 level in the AA genotype was significantly higher than that in the GA and GG genotypes(P<0.05). CONCLUSION Genotype mutations in the C1174 T locus of the TLR5 gene may be a risk factor for CAUTI after cesarean section, and its mechanism needs further study.