急性淋巴细胞白血病化疗后感染外周血cGAS/STING信号通路因子表达

Expressions of cGAS/STING signaling pathway factors in peripheral blood of acute lymphoblastic leukemia patients with infection after chemotherapy

目的探讨急性淋巴细胞白血病(ALL)化疗后感染外周血环鸟苷酸-腺苷酸合成酶(cGAS)/干扰素基因刺激蛋白(STING)信号通路因子表达及临床意义。方法选取2018年1月-2021年12月福建医科大学附属泉州市第一医院血液内科ALL化疗患者101例为ALL组,另选取同期医院体检健康人群30名为对照组,ALL组患者根据化疗后感染发生情况,分为感染组52例与未感染组49例;感染组患者根据感染严重程度,分为危重症感染组15例、重症感染组21例、局部感染组16例。检测外周血单个核细胞cGAS mRNA、STING mRNA表达水平,分析其与化疗后感染发生的关系。结果52例医院感染患者呼吸道感染占比最高为51.92%,革兰阴性菌检出率高于阳性菌与真菌;ALL组患者入院时外周血单个核细胞cGAS mRNA、STING mRNA表达水平高于健康对照组,感染组外周血单个核细胞cGAS mRNA、STING mRNA表达水平高于未感染组(P<0.05);外周血单个核细胞cGAS mRNA、STING mRNA表达水平联合检测评估ALL患者化疗后感染发生受试者工作特征(ROC)曲线下面积高于两项指标单独检测(P<0.05);危重症感染组患者外周血单个核细胞cGAS mRNA、STING mRNA表达水平高于重症感染组,重症感染组患者高于局部感染组(P<0.05)。结论ALL化疗感染最常见类型为呼吸道感染,并以革兰阴性菌为主要病原菌类型,感染发生后患者外周血单个核细胞cGAS mRNA、STING mRNA呈现高表达。

OBJECTIVE To explore the expressions of cyclic guanylate-adenylate synthase(cGAS)/interferon gene-stimulating protein(STING)signaling pathway factors in peripheral blood of acute lymphoblastic leukemia(ALL)patients with infection after chemotherapy.METHODS Totally 101 ALL patients who underwent chemotherapy in hematology department of Quanzhou First Hospital Affiliated to Fujian Medical University from Jan 2018 to Dec 2021 were assigned as the ALL group,meanwhile,30 healthy people who received physical examination were chosen as the control group.The patients of the ALL group were divided into the infection group with 52 cases and the no infection group with 49 cases according to the status of infection after chemotherapy.The patients of the infection group were divided into the critically severe infection group with 15 cases,the severe infection group with 21 cases and the local infection group with 16 cases according to the severity of infection.The expression levels of cGAS mRNA and STING mRNA in peripheral blood mononuclear cells(PBMCs)were detected,and the association with the infection after chemotherapy was observed.RESULTS Among the 52 patients who had nosocomial infection,51.92%had respiratory tract infection.The isolation rate of gram-negative bacteria was higher than that of the gram-positive bacteria and fungi.The expression levels of cGAS mRNA and STING mRNA in peripheral blood PBMCs were higher in the ALL group than in the control group at the admission to hospital;the expression levels of cGAS mRNA and STING mRNA in peripheral blood PBMCs were higher in the infection group than in the no infection group(P<0.05).The area under receiver operating characteristic(ROC)curve of the joint detection of PBMCs cGAS mRNA and STING mRNA was in assessment of infection in the ALL patients after chemotherapy,higher than that of the detection of single index in(P<0.05).The expression levels of cGAS Mrna and STING mRNA in PBMCs were higher in the critically severe infection group than in the severe infection group,and the above indexes of the severe infection group were higher than those of the local infection group(P<0.05).CONCLUSION The respiratory tract infection is the most common types of infection among the ALL patients after chemotherapy,the gram-negative bacteria are dominant among the pathogens,and the patients with infection show high expression levels of cGAS mRNA and STING mRNA in PMBCs.