乳腺癌切除术后感染病原学及与TLR4、STING1基因多态性的关联

Etiological characteristics of postoperative infection in breast cancer patients undergoing mastectomy and association with TLR4,STING1 gene polymorphisms

目的研究乳腺癌切除术后感染病原学及与TOLL受体4(TLR4)、干扰素基因刺激蛋白(STING)1基因多态性的关联。方法回顾性分析2019年6月-2021年6月在上饶市妇幼保健院接受乳腺癌切除术的125例患者临床资料,根据术后感染情况分为感染组9例和未感染组116例。分析术后感染发生部位、病原菌分布、TLR4与STING1基因多态性。结果9例(7.2%)发生术后感染,感染部位以呼吸道和手术切口为主;共分离出17株病原菌,其中革兰阴性菌11株(64.71%),以铜绿假单胞菌为主;革兰阳性菌5株(29.41%),以金黄色葡萄球菌为主;感染组患者TLR4基因rs27371909 GA基因频率高于未感染组(P<0.05),两组患者TLR4基因rs27371909 GG、AA基因以及等位基因频率以及rs10116253基因以及等位基因频率比较,无统计学差异;两组患者STING1 rs1131769等位基因频率比较有统计学意义,但STING1 rs1131769基因频率、rs7380272基因频率和等位基因频率比较,均无统计学差异;TLR4和STING1各个位点基因交互项均无统计学差异。结论医院乳腺癌切除术后感染风险仍较高,携带TLR4 rs27371909 GA基因型患者感染风险升高,病原菌以革兰阴性菌为主,感染部位多见于呼吸道和手术切口。

OBJECTIVE To explore the etiological characteristics of postoperative infection in breast cancer patients undergoing mastectomy and analyze the association with gene polymorphisms of Toll-like receptor 4(TLR4)and stimulator of interferon gene(STING)1.METHODS Totally 125 breast cancer patients who received mastectomy in Shangrao Maternal and Child Health Hospital from Jun 2019 to Jun 2021 were enrolled in the study,the clinical data of the patients were retrospectively analyzed,the patients were divided into the infection group with 9 cases and the no infection group with 116 case according to the status of postoperative infection.The sites of postoperative infection,distribution of pathogens and gene polymorphisms of TLR4 and STING1 were observed.RESULTS Totally 9(7.2%)patients had postoperative infection.The respiratory tract and surgical incision were the major infection sites.A total of 17 strains of pathogens were isolated,11(64.71%)of which were gram-negative bacteria,and 5(29.41%)were gram-positive bacteria;Pseudomonas aeruginosa was the predominant species of the gram-negative bacteria;Staphylococcus aureus was dominant among the gram-positive bacteria.The frequency of GA genotype at rs27371909 locus of TLR4 gene was higher in the infection group than in the no infection group(P<0.05).There were no significant differences in the frequencies of GG,AA genotypes and alleles at rs27371909 locus of TLR4 gene and genotypes and alleles at rs10116253 locus between the two groups of patients.There was significant difference in the frequency of alleles at rs1131769 of STING1 between the two groups of patients,however,there were no significant differences in the frequencies of genotypes at rs1131769 locus of STING1 and the frequencies of genotypes and alleles at rs7380272.There were no significant differences in the gene interactions at the loci of TLR4 and STING1.CONCLUSION The breast cancer patients undergoing mastectomy are still at high risk of postoperative infection,and the patients carrying with GA genotype at rs27371909 locus of TLR4 gene are at higher risk of infection.The gram-negative bacteria are dominant among the pathogens.The respiratory tract and surgical incision are the common infection sites.