胃肠外科术后PICC相关性感染外周血自然杀伤细胞水平及mTOR信号通路变化

Peripheral blood natural killer cells and change of mTOR signaling pathways in gastrointestinal surgery patients with postoperative PICC-related infection

目的分析胃肠外科术后经外周静脉穿刺置入中心静脉导管(PICC)相关性感染患者外周血自然杀伤细胞水平及哺乳动物雷帕霉素靶蛋白(mTOR)信号通路变化。方法选取2020年1月-2021年1月海南医学院第二附属医院收治的外科术后PICC相关性感染患者98例为感染组,同期术后PICC未感染患者50例为未感染组。收集末端导管进行病原菌鉴定,并检测CD_(16)^(+)、CD_(56)^(+)和CD_(59)^(+)和mTOR信号通路的表达,受试者工作特征(ROC)曲线评估CD_(16)^(+)、CD_(56)^(+)、CD_(59)^(+)和mTOR通路对于感染的诊断价值,分析影响胃肠外科术后PICC相关性感染的危险因素。结果革兰阴性菌是胃肠外科术后PICC相关性感染的主要病原菌。感染组患者外周血自然杀伤细胞水平低于未感染组(P<0.05)。与未感染组相比,感染组患者外周血p-mTOR、p-S6K1和p-4EBP1的表达上调(P<0.05)。当CD_(16)^(+)、CD_(56)^(+)和CD_(59)^(+)水平低于0.837%、5.172%和1.625%以及p-mTOR、p-S6K1和p-4EBP1表达高于2.435、1.955和2.074时诊断PICC相关性感染的价值最高(P<0.05)。高水平p-mTOR、p-S6K1和p-4EBP1、盲穿法穿刺方式、夏季置管和PICC脱落均是导致感染风险增加的危险因素(P<0.05)。结论感染患者外周血自然杀伤细胞水平降低,mTOR通路激活,二者或可用于预测和诊断胃肠外科术后PICC相关性感染。

OBJECTIVE To observe the peripheral blood natural killer cells and change of mammalian target of rapamycin(mTOR)signaling pathways in gastrointestinal surgery patients with postoperative peripherally inserted central catheter(PICC)-related infections.METHODS From Jan 2020 to Jan 2021,totally 98 patients who underwent gastrointestinal surgery and had postoperative PICC-related infection in the Second Affiliated Hospital of Hainan Medical University were assigned as the infection group,meanwhile,50 patients who did not have postoperative PICC-related infection were chosen as the no infection group.The specimens collected from catheter ends were cultured for pathogens,the expression levels of CD_(16)^(+),CD_(56)^(+),CD_(59)^(+)and mTOR signaling pathways were detected,the values of CD_(16)^(+),CD_(56)^(+),CD_(59)^(+)and mTOR pathways in diagnosis of infection were assessed by receiver operating characteristic(ROC)curve,and the risk factors for the postoperative PICC-related infection in the gastrointestinal surgery patients were analyzed.RESULTS Gram-negative bacteria were dominant among the pathogens isolated from the gastrointestinal surgery patients with postoperative PICC-related infection.The level of peripheral blood natural killer cells of the infection group was lower than that of the no infection group(P<0.05).The expression levels of peripheral blood p-mTOR,p-S6K1 and p-4EBP1 of the infection group were higher than those of the no infection group(P<0.05).When the levels of CD_(16)^(+),CD_(56)^(+)and CD_(59)^(+)were less than 0.837%,5.172%and 1.625%,and the expression levels of p-mTOR,p-S6K1 and p-4EBP1 were higher than 2.435,1.955 and 2.074,the values were highest in diagnosis of PICC-related infection(P<0.05).High levels of p-mTOR,p-S6K1 and p-4EBP1,blind puncture,catheterization in summer and PICC’s falling off were the risk factors for the infection(P<0.05).CONCLUSION The patients with infection show decline of peripheral blood natural killer cells level and activation of mTOR pathways,which can be used for prediction of postoperative PICC-related infection in the gastrointestinal surgery patients.