妊娠期糖尿病并发感染患者外周血p38-MAPK 信号通路表达及意义

Expression of peripheral blood p38-MAPK signaling pathway in gestational diabetes mellitus patients complicated with infection and its significance

目的 分析妊娠期糖尿病(GDM)并发感染患者外周血p38丝裂原活化蛋白激酶(p38-MAPK)信号通路表达及意义。方法 选取2018年5月-2021年6月杭州市临平区第一人民医院收治的GDM患者165例为研究对象,将62例感染患者纳入感染组,103例无感染患者纳入未感染组,采集患者痰液、尿液及血液等标本,分离培养病原菌进行药敏试验,对比其临床资料及外周血p38-MAPK水平,分析导致GDM并发感染的危险因素。结果62例并发感染以呼吸道、泌尿道感染为主;共分离出病原菌79株,其中革兰阴性菌47株(59.49%)、革兰阳性菌32株(40.51%);肺炎克雷伯菌对氨苄西林完全耐药,对哌拉西林/他唑巴坦、庆大霉素、阿米卡星、氨曲南、亚胺培南、美罗培南均敏感,大肠埃希菌对氨苄西林、哌拉西林耐药率>75%,金黄色葡萄球菌、表皮葡萄球菌对青霉素G耐药率分别为87.50%、83.33%;感染组外周血p38-MAPK、磷酸化-p38MAPK抗体(p-p38-MAPK)、p38-MAPK/p-p38-MAPK高于未感染组(P<0.05);多因素分析发现,住院时间、侵入性操作、使用抗菌药物及外周血p38-MAPK为GDM患者并发感染的危险因素(P<0.05)。结论 GDM患者易受多因素影响并发感染,尤其是p38-MAPK信号通路表达水平发生改变,对其进行监测有重要意义。

OBJECTIVE To observe the expression of peripheral blood p38 mitogen-activated protein kinase(p38-MAPK) signaling pathway in gestational diabetes mellitus(GDM) patients complicated with infection. METHODS A total of 165 GDM patients who were treated in the First People’s Hospital of Linping District from May 2018 to Jun 2021 were recruited as the study subjects, 62 patients who had infection were assigned as the infection group, and 103 patients who did not have infection were set as the no infection group. The sputum, urine and blood specimens were collected from the patients, pathogens were isolated, drug susceptibility testing was performed, clinical data and peripheral blood p38-MAPK level were observed and compared between the two groups, and the risk factors for the infection in the GDM patients were analyzed. RESULTS The patients who had respiratory tract infection and urinary tract infection were dominant among the 62 patients with infection. Totally 79 strains of pathogens were isolated, 47(59.49%) of which were gram-negative bacteria, and 32(40.51%) were gram-positive bacteria. The Klebsiella pneumoniae strains were completely resistant to ampicillin but were sensitive to piperacillin-tazobactam, gentamicin, amikacin, aztreonam, imipenem and meropenem. The drug resistance rates of Escherichia coli strains to ampicillin and piperacillin were more than 75%;the drug resistance rates of Staphylococcus aureus and Staphylococcus epidermidis strains to penicillin G were 87.50% and 83.33%, respectively. The levels of peripheral blood p38-MAPK, phosphorylated-p38 MAPK antibody(p-p38-MAPK) and p38-MAPK/p-p38-MAPK of the infection group were significantly higher than those of the no infection group(P<0.05). Multivariate analysis showed that the length of hospital stay, invasive operation, use of antibiotics and peripheral blood p38-MAPK were the risk factors for the infection in the GDM patients(P<0.05). CONCLUSION There are a variety of influencing factors for the infection in the GDM patients, and it is of great significance to monitor the expression level of p38-MAPK signaling pathway.