IL-10、SP-D基因多态性与糖尿病肾病血液透析肺部感染易感性的关联

Association of susceptibility to pulmonary infection in diabetic nephropathy patients undergoing hemodialysis with polymorphisms of IL-10 and SP-D genes

目的探讨白细胞介素-10(IL-10)、肺表面活性蛋白D(SP-D)基因多态性与糖尿病肾病(DN)血液透析患者肺部感染易感性的关联。方法选取2018年5月-2021年3月新疆医科大学第五附属医院109例DN血液透析患者,将其中合并肺部感染53例患者纳入感染组,未合并肺部感染56例患者纳入未感染组,对IL-10、SP-D基因分型进行检测,比较感染组与未感染组基因型频率,通过Logistic回归分析IL-10、SP-D单核苷酸多态性与DN血液透析患者合并肺部感染的关联。结果感染组53例患者共分离出63株阳性菌株,其中革兰阴性菌43株占比68.25%;感染组患者年龄≥60岁、血清白蛋白<35 g/L的例数高于未感染组(P<0.05);感染组IL-10-rs1800896位点AA基因型、A基因比例低于未感染组,SP-D-rs721917位点CC基因型、C基因比例高于未感染组(P<0.05);Logistic回归分析结果显示年龄≥60岁、SP-D-rs721917位点CC基因型是DN血液透析患者肺部感染的危险因素,血清白蛋白、IL-10-rs1800896位点AA基因型是DN血液透析患者肺部感染的保护因素(P<0.05);感染组IL-10-rs1800896位点AA基因型患者血清IL-10表达水平高于GG或AG基因型,SP-D-rs721917位点CC基因型患者血清SP-D水平低于CT或TT基因型(P<0.05)。结论高龄、低血清白蛋白水平增加DN血液透析患者肺部感染风险,且感染病原菌类型以革兰阴性菌为主,IL-10-rs1800896位点AA基因型是DN血液透析肺部感染的保护基因型,SP-D-rs721917位点CC基因型是肺部感染的危险基因型。

OBJECTIVE To explore the association between the susceptibility to pulmonary infection in diabetic nephropathy(DN)patients undergoing hemodialysis with polymorphisms of interleukin-10(IL-10)and surfactant protein D(SP-D)genes.METHODS A total of 109 DN patients who underwent hemodialysis in the Fifth Affiliated Hospital of Xinjiang Medical University from May 2018 to Mar 2021 were enrolled in the study,53 of whom were complicated with pulmonary infection and assigned as the infection group,56 were not complicated with pulmonary infection and assigned as the no infection group.The genotypes of IL-10 and SP-D were detected,the frequencies of genotypes were compared between the infection group and the no infection group.Logistic regression analysis was performed for the correlation between the single nucleotide polymorphisms of IL-10 and SP-D and the pulmonary infection in the DN patients.RESULTS Totally 63 positive strains were isolated from 53 patients of the infection group,43(68.25%)of which were gram-negative bacteria.The proportions of patients with no less than 60 years of age and serum albumin level less than 35 g/L were higher in the infection group than in the no infection group(P<0.05).The frequencies of AA genotype and A allele at IL-10-rs1800896 locus were lower in the infection group than in the no infection group,while the frequencies of CC genotype and C allele at SP-D-rs721917 locus were higher in the infection group than in the no infection group(P<0.05).The result of logistic regression analysis showed that the no less than 60 years of age and CC genotype at SP-D-rs721917 locus were the risk factors for pulmonary infection in the DN patients undergoing hemodialysis;the serum albumin level and AA genotype at IL-10-rs1800896 locus were the protective factors for pulmonary infection in the DN patients undergoing hemodialysis(P<0.05).In the infection group,the serum IL-10 level of the patients with AA genotype at IL-10-rs1800896 locus was higher than that of the patients with GG or AG genotype,while the serum SP-D level of the patients with CC genotype at SP-D-rs721917 locus was lower than that of the patients with CT or TT genotype(P<0.05).CONCLUSION The advanced age and low level of serum albumin may increase the risk of pulmonary infection in the DN patients undergoing hemodialysis,the gram-negative bacteria are dominant among the pathogens.The AA genotype at IL-10-rs1800896 locus is a protective genotype for pulmonary infection,and the CC genotype at SP-D-rs721917 locus is a risk genotype for pulmonary infection.