主动脉夹层支架植入手术后医院感染危险因素及与miR-146a、miR-155的关系

Risk factors for postoperative nosocomial infection in aortic dissection patients undergoing stent implantation and relationship with miR-146a and miR-155

目的探究主动脉夹层支架植入手术后医院感染危险因素及与miR-146a、miR-155水平的关系。方法分析2020年4月-2021年4月南阳医学高等专科学校第一附属医院收治的主动脉夹层患者的临床资料,将35例并发术后医院感染患者分为感染组,随机选取同期123例未感染患者为未感染组,分析感染患者病原菌检出情况及发生感染的危险因素。比较两组外周血miR-146a、miR-155水平,通过受试者工作特征曲线(ROC)评估外周血miR-146a、miR-155对并发医院感染的预测价值。结果35例主动脉夹层支架植入手术术后医院感染患者共检出62株病原菌,其中革兰阴性菌47株,占比75.81%;感染组年龄≥60岁、糖尿病史、术前脏器缺血、美国纽约心脏病协会(NYHA)心功能分级≥Ⅲ级、吸烟史、输血浆量≥1500 ml、辅助通气时间≥7 d、急性肾衰竭床旁血滤、术后气管切开比例高于非感染组(P<0.05);Logistic回归分析显示,术前NYHA分级≥Ⅲ级、输血浆量≥1500 ml、辅助通气时间≥7 d是主动脉夹层支架植入手术患者医院感染危险因素(P<0.05);感染组外周血miR-146a、miR-155水平均高于非感染组(P<0.05);ROC曲线显示,外周血miR-146a、miR-155水平单独检测及联合检测可作为主动脉夹层支架植入手术患者医院感染早期预测指标。结论主动脉夹层支架植入手术患者医院感染以革兰阴性菌为主,其易感性与外周血miR-146a、miR-155水平有关。

OBJECTIVE To explore the risk factors for postoperative nosocomial infection in aortic dissection patients undergoing stent implantation and analyze the relationship with miR-146 a and miR-155. METHODS The clinical data of the patients with aortic dissection who were treated in the First Affiliated Hospital of Nanyang Medical College from Apr 2020 to Apr 2021 were analyzed, 35 patients who were complicated with postoperative nosocomial infection were assigned as the infection group, meanwhile, 123 patients who did not have infection were chosen as the no infection group. The pathogens isolated from the patients with infection and the risk factors for infection were observed. The levels of peripheral blood miR-146 a and miR-155 were compared between the two groups, and the values of peripheral blood miR-146 a and miR-155 in prediction of nosocomial infection were evaluated by means of receiver operating characteristic(ROC) curve. RESULTS Totally 62 strains of pathogens were isolated from the 35 aortic dissection patients with postoperative nosocomial infection, 47(75.81%) of which were gram-negative bacteria. The proportions of patients with no less than 60 years of age, history of diabetes mellitus, preoperative organ ischemia, New York Heart Association(NYHA) cardiac function classification no less than grade Ⅲ, smoking history, volume of plasma transfusion no less than 1 500 ml, mechanical ventilation duration no less than 7 days, acute renal failure bedside hemofiltration and postoperative tracheotomy were significantly higher in the infection group than in the no infection group(P<0.05).Logistic regression analysis showed that preoperative NYHA classification no less than grade Ⅲ, volume of plasma transfusion no less than 1 500 ml and mechanical ventilation no less than 7 days were the risk factors for nosocomial infection in the aortic dissection patients undergoing stent implantation(P<0.05). The levels of peripheral blood miR-146 a and miR-155 of the infection group were significantly higher than those of the no infection group(P<0.05). ROC curve analysis indicated that the single detection of peripheral blood miR-146 a or miR-155 and the joint detection could serve as the indexes for early prediction of nosocomial infection in the aortic dissection patients undergoing stent implantation. CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the aortic dissection patients undergoing stent implantation, and the susceptibility is associated with the levels of peripheral blood miR-146 a and miR-155.