直肠癌根治术后结肠造口感染患者肠道微环境及CD36/mTORC1信号通路表达

Intestinal microenvironment and expressions of CD36/mTORC1 pathways in patients with colostomy infection after radical resection of rectal cancer

目的 探究直肠癌根治术后结肠造口感染与患者肠道微环境及外周血分化抗原36(CD36)/哺乳动物雷帕霉素靶蛋白复合物1(mTORC1)通路蛋白表达的关系.方法 选取2016年6月-2021年6月武汉理工大学医院收治的284例直肠癌根治术后结肠造口患者为研究对象,根据术后是否并发造口感染分为感染组(n=82)、对照组(n=202),采用实时荧光定量聚合酶链反应(PCR)法检测患者肠道菌群及CD36/mTORC1 mRNA表达.采用多因素Logistic回归分析直肠癌根治术后造口感染的影响因素,绘制受试者工作特征(ROC)曲线探究CD36/mTORC1 mRNA表达对术后造口感染预测价值.结果 感染组大肠埃希菌、肠球菌数量高于对照组(P<0.05),双歧杆菌、乳酸杆菌数量低于对照组(P<0.05);两组菌群失调分度差异有统计学意义(P<0.05),且感染组Ⅲ度失调比例高于对照组(P<0.05);感染组CD36 mRNA、mTORC1 mRNA水平均高于对照组(P<0.05);菌群失调Ⅲ度、CD36 mRNA、mTORC1 mRNA是直肠癌根治术后结肠造口感染的影响因素(P<0.05);CD36 mRNA、mTORC1 mRNA预测术后造口感染的ROC曲线下面积分别为0.887、0.958.结论 直肠癌根治术后结肠造口患者存在肠道菌群失衡,且可能通过激活外周血CD36/mTORC1信号通路增加患者造口感染风险.

OBJECTIVE To investigate the relationship between colostomy infection after radical resection of rectal cancer and the intestinal microenvironment and expressions of peripheral blood cluster of differentiation 36(CD36)/mammalian target of rapamycin complex 1(mTORC1)pathway proteins.METHODS A total of 284 patients with colostomy after radical resection of rectal cancer who were admitted to the Hospital of Wuhan University of Technology between Jun.2016 and Jun.2021 were selected as the research subjects,and were divided into infection group(n=82)and control group(n=202)according to whether patients were complicated with stoma infection after surgery.Real-time fluorescent quantitative polymerase chain reaction(PCR)was used to detect the intestinal flora and mRNA expressions of CD36/mTORC1 of patients.Multivariate Logistic regression analysis was applied to analyze the influencing factors of stoma infection after radical rectal cancer surgery,and the receiver operating characteristic(ROC)curve was drawn to explore the predictive value of mRNA expressions of CD36/mTORCl on postoperative stoma infection.RESULTS The counts of Escherichia coli and Enterococcus in infection group were higher than those in control group(P<0.05)while the counts of Bifidobacterium and Lactobacillus were lower than those in control group(P<o.O5).There was a statistical significance in the degree of intestinal flora imbalance between the two groups(P<0.05),and the proportion of the Ill degree imbalance in infection group was higher compared with that in control group(P<0.05).The expression levels of CD36 mRNA and mTORCl mRNA in infection group were higher than those in control group(P<o.O5).Multivariate Logistic regression analysis showed that the III degree of flora imbalance,CD36 mRNA and mTORCl mRNA were the influencing factors of colostomy infection after radical resection of rectal cancer(P<0.05).The areas under the ROC curves of CD36 mRNA and mTORC1 mRNA in predicting postoperative stoma infection were 0.887 and 0.958 respectively.CONCLUSION Patients with colostomy after radical resection of rectal cancer had intestinal flora imbalance and might be at increased risk of stoma infection through the activation of the peripheral blood CD36/mTORC1 signaling pathways.