TLR9信号通路在深静脉穿刺致全身性炎症感染患者外周血中的表达及意义

Expression of TLR9 signaling pathway in peripheral blood of patients with deep venous puncture-induced systemic inflammation and its significance

目的 分析Toll样受体9(TLR9)信号通路在深静脉穿刺致全身性炎症感染患者外周血中的表达及意义。方法 选取宁波市医疗中心李惠利医院东部院区2018年2月-2019年12月192例中心静脉导管(CVC)置管术后疑似导管相关性血流感染(CRBSI)患者为研究对象,其中54例根据血培养确诊为CRBSI(CRBSI组),138例为非CRBSI(非CRBSI组),比较两组患者外周血单个核细胞(PBMCs)中TLR9、核因子-κB(NF-κB)信使核糖核酸(mRNA)表达水平及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平,受试者工作特征(ROC)曲线评估上述指标对CVC置管后CRBSI的预测价值。结果 CRBSI组股静脉插管率、CVC置管时间、糖尿病患病率高于非CRBSI组(P<0.05),血清白蛋白水平低于非CRBSI组(P<0.05)。CRBSI组外周血PBMCs中TLR9、NF-κB mRNA表达及血清TNF-α、IL-6水平均高于非CRBSI组(P<0.05),ROC曲线分析结果,外周静脉血PBMCs中TLR9、NF-κB mRNA及血清TNF-α、IL-6检测对CRBSI具有较高预测价值,曲线下面积(AUC)分别为0.944、0.924、0.913、0.882。结论 TLR9信号通路可能参与深静脉穿刺置管所致全身性感染的发生发展,积极监测相关指标对深静脉穿刺致全身性感染诊疗有利。

OBJECTIVE To observe the expression of Toll-like receptor 9(TLR9) signaling pathway in peripheral blood of patients with deep venous puncture-induced systemic inflammation and analyze its significance. METHODS From Feb 2018 to Dec 2019, a total of 192 patients who had suspected catheter-related bloodstream infection(CRBSI) in Eastern District of Li Huili Hospital, Ningbo Medical Center after central venous catheterization(CVC) were recruited as the study subjects, 54 of whom were diagnosed with CRBSI based on blood culture and were assigned as the CRBSI group, and 138 patients who were diagnosed with non-CRBSI and were set as the non-CRBSI group. The expression levels of peripheral blood mononuclear cells(PBMCs), nuclear factor-κB(NF-κB) messenger ribonucleic acid(mRNA) and serum tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) were compared between the two groups of patients, and the values of the above indexes in prediction of CRBSI among the CVC patients were assessed by means of receiver operating characteristic(ROC) curve. RESULTS The rate of femoral vein intubation, duration of CVC and morbidity of diabetes mellitus of the CRBSI group were significantly higher than those of the non-CRBSI group(P<0.05), the serum albumin level of the CRBSI group was significantly lower than that of the non-CRBSI group(P<0.05). The expression levels of TLR9, NF-κB mRNA in PBMCs of peripheral blood and serum TNF-α and IL-6 were significantly higher in the CRBSI group than in the non-CRBSI group(P<0.05). The result of ROC curve analysis showed that the TLR9, NF-κB mRNA in PBMCs of peripheral blood, serum TNF-α and IL-6 had high value in prediction of CRBSI, and the areas under curve(AUCs) were 0.944, 0.924, 0.913 and 0.882, respectively. CONCLUSION The TLR9 signaling pathway may be involved in the occurrence and development of systemic infection induced by deep venous puncture catheterization, and active monitoring of the related indexes may facilitate the diagnosis and treatment of the systemic infection.