皮瓣修复术后早期感染血浆NLRP3炎症小体-IL-1β信号通路的表达

Expression of plasma NLRP3 inflammasome-IL-1β signaling pathway in flap repair patients with postoperative early infection

目的分析皮瓣修复术后早期感染血浆核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎症小体-白细胞介素-1β(IL-1β)信号通路的表达。方法选择2019年1月-2020年1月华中科技大学协和江北医院收治的行皮瓣修复术患者121例,根据术后1周内手术部位是否感染分为感染组36例和未感染组85例,感染组患者根据感染深浅分为深部感染组21例和浅部感染组15例,分析感染组患者病原菌检出情况,采用实时荧光定量聚合酶链式反应(RT-PCR)法检测各组患者血浆NLRP3、接头蛋白凋亡相关斑点样蛋白(ASC)以及效应蛋白半胱天冬酶-1(Caspase-1)mRNA表达,采用酶联免疫吸附测定(ELISA)法检测血清IL-1β、IL-18水平。结果36例感染患者共分离病原菌株43株,其中革兰阳性菌占60.47%(26/43),革兰阴性菌占39.53%(17/43)。感染组患者血浆NLRP3、ASC和Caspase-1 mRNA表达量均高于未感染组(P<0.05),血清IL-1β、IL-18水平均高于未感染组(P<0.05)。深部感染组患者血浆NLRP3、ASC和Caspase-1 mRNA表达量及血清IL-1β、IL-18水平均高于浅部感染组患者(P<0.05)。结论皮瓣修复术后早期感染以革兰阳性菌感染为主,NLRP3炎症小体-IL-1β信号通路可能参与了皮瓣修复术后早期感染过程。

OBJECTIVE To explore the expression of plasma nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome-interleukin-1β(IL-1β)signaling pathway in flap repair patients with postoperative infection.METHODS A total of 121 patients who underwent flap repair surgery in Xiehe Jiangbei Hospital,Huazhong University of Science and Technology from Jan 2019 to Jan 2020 were enrolled in the study and divided into the infection group with 36 cases and the no infection group with 85 cases according to the status of surgical site infection within 1 week after surgery.The patients of the infection group were divided into the deep infection group with 21 cases and the superficial infection group with 15 cases.The distribution of pathogens isolated from the infection group was observed,the expression levels of plasma NLRP3,adaptor protein apoptosis-associated speck-like protein(ASC)and effector protein caspase-1(Caspase-1)mRNA were detected by using real-time fluorescent quantitative polymerase chain reaction(RT-PCR),and the levels of serum IL-1βand IL-18 were detected by means of enzyme-linked immunosorbent assay(ELISA).RESULTS Totally 43 strains of pathogens were isolated from 36 patients with infection,60.47%(26/43)of which were gram-positive bacteria,39.53%(17/43)were gram-negative bacteria.The expression levels of plasma NLRP3,ASC and Caspase-1 mRNA of the infection group were significantly higher than those of the no infection group(P<0.05),the levels of serum IL-1βand IL-18 of the infection group were significantly higher than those of the no infection group(P<0.05).The expression levels of plasma NLRP3,ASC and Caspase-1 mRNA as well as the levels of serum IL-1βand IL-18 were significantly higher in the deep infection than in the superficial infection group(P<0.05).CONCLUSION The gram-positive bacteria are dominant among the pathogens isolated from the flap repair patients with postoperative early infection,and the NLRP3 inflammasome-IL-1βsignaling pathway may be involved in the process of postoperative early infection in the flap repair patients.