重症急性胰腺炎继发感染影响因素及其与miR-216a-PTEN水平的关系

Risk factors of infection secondary to severe acute pancreatitis and its relationship with miR-216a-PTEN signaling pathway molecules

目的 分析重症急性胰腺炎(SAP)继发感染的影响因素及其与微小RNA-216a(miR-216a)-磷酸酶及张力蛋白同源的基因(PTEN)的关系。方法 收集2020年2月-2022年2月新乡市中心医院普瘤三科收治的SAP患者96例为研究对象,分析SAP患者继发感染和病原菌及耐药情况,归纳SAP患者继发感染的影响因素,分析miR-216a-PTEN信号通路分子与SAP继发感染的关系。结果 SAP继发感染29例,感染发生率为30.21%(29/96);29例SAP继发感染患者腹水标本,检出病原菌41株,其中革兰阴性菌24株占58.54%,以鲍氏不动杆菌为主,革兰阳性菌12株占29.27%,真菌5株占12.20%;鲍氏不动杆菌对美罗培南、亚胺培南、头孢曲松、头孢吡肟、左氧氟沙星、庆大霉素、丁胺卡那霉素常用抗菌药物耐药率较高(>80%),对替加环素、头孢哌酮/舒巴坦敏感性高,大肠埃希菌对头孢曲松、头孢吡肟、左氧氟沙星耐药率较高(均>70%),而对美罗培南、亚胺培南、丁胺卡那霉素耐药率较低,金黄色葡萄球菌对多数抗菌药物耐药率高,仅对利奈唑胺、呋喃坦啶、万古霉素耐药率低;miR-216a mRNA、PTEN mRNA、PTEN蛋白与SAP继发感染的发生相关(P<0.05)。结论 SAP继发感染病原菌以革兰阴性菌为主,抗感染治疗需依据药敏试验选择合理抗菌药物,miR-216a-PTEN信号通路分子参与SAP继发感染,有望为SAP继发感染新的治疗潜在靶点提供新思路。

OBJECTIVE To analyze the risk factors of infection secondary to severe acute pancreatitis(SAP), and its relationship with microRNA-216 a(miR-216 a)-phosphatase and tensin homolog(PTEN) signaling pathway molecules. METHODS Totally 96 patients with SAP admitted to the Third Department of General Oncology, Xinxiang Central Hospital between Feb. 2020 and Feb. 2022 were selected as the study subjects. The incidence of secondary infection, distribution and drug resistance of pathogenic bacteria were analyzed, and the risk factors of secondary infection were determined. The relationship between miR-216 a-PTEN signaling pathway molecules and infection secondary to SAP was analyzed. RESULTS There were 29 cases of SAP secondary infection, and the infection rate was 30.21%(29/96);41 strains of pathogenic bacteria were detected in the ascites samples of 29 patients with secondary infection of sap, including 24 strains of Gram-negative bacteria, 58.54%, mainly Acinetobacter baumannii, 12 strains of Gram-positive bacteria, 29.27%, and 5 strains of fungi, 12.20%;Acinetobacter baumannii has a high resistance rate(>80%) to meropenem, imipenem, ceftriaxone, cefepime, levofloxacin, gentamicin and amikacin, and is highly sensitive to tegacyclin and sulperazone. Escherichia coli has a high resistance rate to ceftriaxone, cefepime and levofloxacin(all>70%), while the resistance rate to meropenem, imipenem and amikacin is low, Staphylococcus aureus has high resistance to most antibiotics, but low resistance to linezolid, furazolidine and vancomycin;Mir-216 a mRNA, PTEN mRNA and PTEN protein were correlated with the occurrence of secondary infection of sap(P<0.05). CONCLUSION Gram-negative bacteria is main pathogenic bacteria of infection secondary to SAP infection. Antibacterial drugs for anti-infection treatment should be selected based on drug sensitivity test. miR-216 a-PTEN signaling pathway molecules participates in infection secondary to SAP, which provides an idea for finding a potential target to treat infection secondary to SAP.