慢性化脓性中耳炎真菌感染危险因素及与Dectin-1基因多态性的关联

Risk factors for fungal infection in patients with chronic suppurative otitis media and association with Dectin-1 gene polymorphism

目的 分析慢性化脓性中耳炎真菌感染危险因素及与树突状细胞相关C型凝集素-1(Dectin-1)基因多态性的关联。方法 回顾性分析2017年8月-2021年8月嘉兴市第二医院收治的慢性化脓性中耳炎患者100例病例资料,根据是否感染真菌分为感染组38例和非感染组62例。比较两组患者临床一般资料,采用Logistic多因素回归分析慢性化脓性中耳炎发生真菌感染的危险因素,采用流式细胞仪检测外周血CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)和CD_(4)^(+)/CD_(8)^(+)比值,免疫比浊法检测患者血清免疫球蛋白(Ig)G、IgA、IgM,限制性片段长度多态性聚合酶链反应(PCR-RFLP)检测Dectin-1基因型分布。结果 慢性化脓性中耳炎合并真菌感染患者年龄>60岁比例、既往存在中耳炎史比例、合并糖尿病比例、上呼吸道感染比例、变应性鼻炎比例和抗菌药物滥用比例均高于非感染组患者(P<0.05),Logistic回归分析结果显示,年龄、滥用抗菌药物和合并糖尿病是慢性化脓性中耳炎患者发生真菌感染的危险因素(P<0.05)。感染组患者免疫球蛋白(IgG、IgA、IgM)和T淋巴细胞亚群(CD_(4)^(+)、CD_(8)^(+)和CD_(4)^(+)/CD_(8)^(+)比值)低于非感染组(P<0.05)。两组患者基因型及等位基因分布比较,无统计学差异。感染组携带Dectin-1等位基因型(GG和TT)患者血清免疫球蛋白(IgA、IgM)和T淋巴细胞亚群(CD_(4)^(+)、CD_(8)^(+)和CD_(4)^(+)/CD_(8)^(+)比值)水平低于携带GT患者(P<0.05)。结论 慢性化脓性中耳炎患者携带Dectin-1等位基因患者可能免疫功能低下,可影响疾病的发展。

OBJECTIVE To analyze the risk factors for fungal infection in the patients with chronic suppurative otitis media and analyze the association with dendritic cell-associated C-type lectin-1(Dectin-1) gene polymorphism. METHODS A total of 100 patients with chronic suppurative otitis media who were treated in the Jiaxing Second Hospital from Aug 2017 to Aug 2021 were enrolled in the study and divided into the infection group with 38 cases and the no infection group with 62 cases according to the status of fungal infection. The data of the enrolled patients were retrospectively analyzed. The baseline clinical data were compared between the two groups of patients. Multivariate logistic regression analysis was performed for the risk factors for the fungal infection in the patients with chronic suppurative otitis media. The levels of peripheral blood CD_(3)^(+), CD_(4)^(+), CD_(8)^(+)and CD_(4)^(+)/CD_(8)^(+)ratio were detected by flow cytometry, the levels of serum immunoglobulin(Ig)G, IgA and IgM of the patients were detected by immunoturbidimetry, and the Dectin-1 genotypes were detected by means of polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). RESULTS The proportions of patients with more than 60 years of age, previous history of otitis media, diabetes mellitus, upper respiratory tract infection, allergic rhinitis and antibiotic abuse were significantly higher in the infection group than in the no infection group(P<0.05). The result of logistic regression analysis showed that the age, antibiotic abuse and complication with diabetes mellitus were the risk factors for the fungal infection in the patients with chronic suppurative otitis media(P<0.05). The levels of immunoglobulins(IgG, IgA, IgM) and T lymphocytes subsets(CD_(4)^(+),CD_(8)^(+)and CD_(4)^(+)/CD_(8)^(+)ratio) were significantly lower in the infection group than in the no infection group(P<0.05). There were no significant differences in the distributions of genotypes and alleles between the two groups of patients. In the infection group, the levels of serum immunoglobulins(IgA, IgM) and T lymphocytes subsets( CD_(4)^(+), CD_(8)^(+), CD_(4)^(+)/CD_(8)^(+)ratio) of the patients carried with Dectin-1 allele genotypes(GG and TT) were significantly lower than those of the patients carried with GT(P<0.05). CONCLUSION The chronic suppurative otitis media patients who carry with Dectin-1 alleles may have lower immune function, which may affect the progression of disease.