维持性血液透析患者微炎症状态及外周血 Keap1-Nrf2-ARE表达对导管相关性血流感染的诊断价值

Microinflammatory status of maintenance hemodialysis patients and value of peripheral blood Keap1-Nrf2-ARE in diagnosis of catheter-related bloodstream infection

目的 探究维持性血液透析(MHD)患者微炎症状态及外周血Kelch样环氧氯丙烷相关蛋白-1(Keap1)-核因子E2-相关因子2(Nrf2)-抗氧化反应元件(ARE)表达对导管相关性血流感染(CRBSI)的诊断价值。方法 选取武汉市第一医院2020年8月-2021年8月收治的23例MHD合并CRBSI患者为感染组,同期收治的未发生CRBSI的MHD患者67例为非感染组。采集CRBSI患者外周静脉血及导管血样本行病原菌培养,绘制受试者工作特征(ROC)曲线分析微炎症状态及Keap1、Nrf2、ARE表达对MHD合并CRBSI的诊断价值。结果 合并CRBSI患者共检出30株病原菌,革兰阳性菌占60.00%(18/30),革兰阴性菌占33.33%(10/30),真菌占6.67%(2/30);感染组血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均高于非感染组(P<0.05),超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平及Keap1、Nrf2、ARE mRNA均低于非感染组(P<0.05);CRP、IL-6、TNF-α联合评估MHD合并CRBSI的曲线下面积(AUC)为0.855,敏感度为73.91%、特异度为92.54%;Keap1、Nrf2、ARE联合评估MHD合并CRBSI的AUC为0.859,敏感度为91.30%、特异度为70.15%。结论 MHD患者微炎症状态及外周血Keap1-Nrf2-ARE表达对CRBSI有较高的诊断价值,临床应密切监测MHD患者血清CRP、IL-6、TNF-α水平及Keap1、Nrf2、ARE相对表达量,及时防治CRBSI。

OBJECTIVE To explore the microinflammatory status of maintenance hemodialysis(MHD) patients and analyze the value of Kelch-like epichlorohydrin-associated protein-1(Keap1)-nuclear factor E2-related factor 2(Nrf2)-antioxidant responsive element(ARE) in diagnosis of catheter-related bloodstream infection(CRBSI). METHODS A total of 23 MHD patients who were complicated with CRBSI and treated in Wuhan First Hospital from Aug 2020 to Aug 2021 were assigned as the infection group, meanwhile, 67 MHD patients who did not have CRBSI were chosen as the non-infection group. The peripheral venous blood and catheter blood samples were collected from the patients with CRBSI, and the values of microinflammatory status, Keap1, Nrf2 and ARE of the MHD patients in diagnosis of CRBSI were analyzed by receiver operating characteristic(ROC) curves. RESULTS Totally 30 strains of pathogens were isolated from the patients complicated with CRBSI, 60.00%(18/30) of which were gram-positive bacteria, 33.33%(10/30) were gram-negative bacteria, and 6.67%(2/30) were fungi. The levels of serum C-reactive protein(CRP), interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) of the infection group were higher than those of the non-infection group(P<0.05), while the levels of superoxide dismutase(SOD), glutathion peroxidase(GSH-Px),Keap1, Nrf2 and ARE mRNA of the infection group were lower than those of the non-infection group(P<0.05). The area under curve(AUC) of the joint detection of CRP, IL-6 and TNF-α was 0.855 in assessment of CRBSI in the MHD patients, with the sensitivity 73.91%, the specificity 92.52%. The AUC of the joint detection of Keap1, Nrf2 and ARE was 0.859 in assessment of CRBSI in the MHD patients, with the sensitivity 91.30%, the specificity 70.15%. CONCLUSION The microinflammatory status and peripheral blood Keap1-Nrf2-ARE have high value in diagnosis of CRBSI in the MHD patients. It is necessary for the hospital to closely monitor the levels of serum CRP, IL-6 and TNF-α as well as the relative expression levels of Keap1, Nrf2 and ARE so as to prevent CRBSI in a timely manner.