心胸外科术后手术部位感染游离中性粒细胞胞外诱捕网DNA水平及其短期预后价值

Cell-free DNA/nertrophil extracellular traps of cardiothoracic surgery patients with postoperative surgical site infection and its value in assessment of short-term prognosis

目的 探讨心胸外科术后手术部位感染患者中性粒细胞胞外诱捕网(NETs)水平变化及其评估短期预后的临床价值。方法 选择江苏大学附属武进人民医院心胸外科2015年1月-2021年1月进行手术并在住院期间发生手术部位感染(SSI)患者72例为研究对象,通过电子病历收集患者临床资料,随访患者术后30 d预后情况,分析血浆cfDNA/NETs水平动态变化及其评估短期预后的临床价值。结果 72例纳入患者共培养出病原菌61株,其中革兰阴性菌33株,占54.10%,革兰阳性菌27株,占44.26%,真菌1株,占1.64%,根据患者30 d预后情况分为预后不良组19例和预后良好组53例。两组患者术前APACHEⅡ评分和COUNT评分,术后有创机械通气时间比较差异有统计学意义(P<0.05),两组患者术前、术后1 d、3 d cfDNA/NETs水平比较差异无统计学意义,预后不良组术后7 d cfDNA/NETs水平高于预后良好组(P<0.05),ROC分析结果显示,术后7 d cfDNA/NETs对心胸外科术后手术部位感染患者短期预后不良预测曲线下面积为0.841, 95%CI为0.727~0.924,特异度为81.34%,敏感度为67.97%。结论 对于心胸外科术后手术部位感染患者,临床医师可针对术前APACHEⅡ评分、术前COUNT评分、有创机械通气时间和血浆cfDNA/NETs水平进行针对性干预,以期改善预后。

OBJECTIVE To explore the changes of neutrophil extracellular traps(NETs) in cardiothoracic surgery patients with postoperative surgical sites infection(SSI) and analyze its clinical values in assessment of short-term prognosis. METHODS From Jan 2015 to Jan 2021, a total of 72 patients who underwent surgery in cardiothoracic surgery department of Wujin People′s Hospital Affiliated to Jiangsu University and had SSI during hospital stay were recruited as the study sujects, the clinical data were collected by electronic medical record, the follow-up was conducted for the prognosis of the patients after the surgery for 30 days, the dynamic changes of plasma cfDNA/NETs and the clinical value in assessment of short-term prognosis were observed. RESULTS Totally 61 strains of pathogens were isolated from 72 patients, 33(54.10%) of which were gram-negative bacteria, 27(44.26%) were gram-positive bacteria, and 1(1.64%) was fungus. The patients were divided into the poor prognosis group with 19 cases and the good prognosis group with 53 cases according to the 30-day prognosis. There were significant differences in the preoperative APACHE Ⅱ score, COUNT score and duration of postoperative invasive mechanical ventilation between the two groups(P<0.05). There was no significant difference in the cfDNA/NETs level between the two groups before the surgery and after the surgery for 1 and 3 days. The cfDNA/NETs level of the poor prognosis group was significantly higher than that of the good prognosis group after the surgery for 7 days(P<0.05). The result of ROC analysis showed that the area under curve of the cfDNA/NETs after the surgery for 7 days was 0.841 in prediction of short-term prognosis of the cardiothoracic surgery patients with SSI, with 95%CI 0.727-0.924, the specificity 81.34%, the sensitivity 67.97%. CONCLUSION The clinicians can take targeted interventions to the cardiothoracic surgery patients with postoperative SSI based on the preoperative APACHE Ⅱ score, preoperative COUNT score, duration of invasive mechanical ventilation and plasma cfDNA/NETs level so as to improve the prognosis.