DEFB1基因多态性与长期血液透析患者发生导管相关血流感染的关联

Association of polymorphisms of DEFB1 gene with catheter-related bloodstream infection in patients undergoing long-term hemodialysis

目的分析β-防御素-1(DEFB1)基因多态性与长期血液透析患者发生导管相关血流感染(CRBSI)的关联。方法选取2019年1月-2021年6月杭州市萧山区中医院诊治的80例慢性肾脏病患者,根据是否发生CRBSI将患者分为感染组26例和未感染组54例。提取两组患者外周血DNA,经聚合酶链式扩增反应(PCR)及测序技术检测DEFB1基因多态性,比较两组临床资料和肾性贫血指标[钙、磷、铁、全血血红蛋白(Hb)、甲状旁腺激素(PTH)]和免疫功能指标[免疫球蛋白G(IgG)、IgM],分析各位点多态性与CRBSI感染易感性的关系,采用Logistic分析长期血液透析患者发生CRBSI的影响因素。结果感染组患者血清白细胞计数(WBC)、C-反应蛋白(CRP)、钙水平高于未感染组,血清磷、IgG、IgM水平低于未感染组(P<0.05);DEFB1-688G/C位点等位基因及基因型在感染组与未感染组的分布,差异有统计学意义(P<0.05),且该位点C等位基因与CRBSI易感性存在相关性(P<0.05);透析时间≥4年、-688G/C基因型CC是影响血液透析患者发生CRBSI的危险因素(P<0.05)。结论长期血液透析患者血清钙磷紊乱、免疫功能下降;DEFB1基因-688G/C多态性可能与血液透析患者CRBSI的发生关系密切。

OBJECTIVE To analyze the association of polymorphisms ofβ-Defensin-1(DEFB1)gene with catheter-related bloodstream infection(CRBSI)in patients undergoing long-term hemodialysis.METHODS A total of 80 patients with chronic kidney disease who were treated in Xiaoshan District Hospital of Traditional Chinese Medicine from Jan 2019 to Jun 2021 were enrolled in the study and divided into the infection group with 26 cases and the no infection group with 54 cases according to the status of CRBSI.Peripheral blood DNA of the two groups of patients were extracted,the polymorphisms of DEFB1 gene were detected by polymerase chain reaction(PCR)and sequencing technology.The clinical data,renal anemia indexes[calcium,phosphorus,iron,whole blood hemoglobin(Hb),parathyroid hormone(PTH)]and immune function indexes[immunoglobin G(IgG),IgM]were compared between the two groups.The relationship between the polymorphisms at the loci and the susceptibility to CRBSI was observed.Logistic analysis was performed for influencing factors for CRBSI in the patients undergoing long-term hemodialysis.RESULTS The levels of serum white blood cell(WBC),c reactive protein(CRP)and calcium of the infection group were higher than those of the no infection group,while the levels of serum phosphorus,IgG and IgM of the infection group were lower than those of the no infection group(P<0.05).There were significant differences in the alleles and genotypes at-688G/C locus of DEFB1 gene between the infection group and the no infection group(P<0.05),and the allele C at the locus was associated with the susceptibility to CRBSI(P<0.05).No less than 4 years of dialysis and genotype CC at-688G/C locus were the risk factors for CRBSI in the hemodialysis patients(P<0.05).CONCLUSION The patients undergoing long-term hemodialysis show the disorders of serum calcium and phosphorus and decline of immune function.The polymorphisms at-688G/C locus of DEFB1 gene are closely associated with the incidence of CRBSI in the hemodialysis patients.