糖尿病肾病合并肺部感染病原学与危险因素及与PTX3基因多态性的关联

Etiological characteristics and risk factors for pulmonary infection in diabetic nephropathy patients and association with PTX3 gene polymorphism

目的探究糖尿病肾病(DN)合并肺部感染的病原学、危险因素和正五聚蛋白-3(PTX3)基因多态性特征。方法选取2020年1月-2021年1月甘肃兰州大学第二医院收治的DN患者183例为病例组,根据是否并发肺部感染分为感染组和未感染组,另选取健康体检者205名为对照组。聚合酶链式反应(PCR)技术检测PTX3基因多态性,酶联免疫吸附法检测血清PTX3表达水平;Logistic回归分析法分析患者并发肺部感染的相关因素。结果183例DN患者发生肺部感染51例(27.87%);共检出感染病原菌78株,包括革兰阴性菌49株(62.82%),革兰阳性菌25株(32.05%),真菌4株(5.13%)。感染组、未感染组与对照组PTX3基因rs2305619、rs1840680位点的基因型频率及rs1840680位点等位基因频率比较,差异均有统计学意义(P<0.05)。三组血清PTX3水平比较,感染组>未感染组>对照组(P<0.05)。Logistic回归分析结果显示,糖尿病病程、住院时间、维持性血液透析情况、肾功能、血清PTX3和PTX3基因rs1840680位点多态性是DN患者并发肺部感染的影响因素(P<0.05)。结论DN患者并发肺部感染的病原菌分布具有一定特征性,糖尿病病程、住院时间、维持性血液透析情况、肾功能、PTX3基因中的rs1840680位点基因多态性及其血清水平是影响DN患者并发肺部感染的相关因素。

OBJECTIVE To investigate the etiological characteristics,risk factors and pentraxin-3(PTX3)gene polymorphism in diabetic nephropathy(DN)patients complicated with pulmonary infection.METHODS A total of 183 patients with DN admitted to the Second Hospital of Lanzhou University from Jan 2020 to Jan 2021 were enrolled as the case group.According to whether pulmonary infection occurred,the patients were divided into the infected group and uninfected group.Another 205 healthy volunteers were recruited in the control group.PTX3 gene polymorphism was detected by PCR method,and serum PTX3 level was detected by enzyme-linked immunosorbent assay.Multivariate logistic regression analysis was performed to screen the influencing factors for pulmonary infection.RESULTS Fifty-one(27.87%)of the 183 patients with DN developed pulmonary infection.A total of 78 strains were detected in patients with pulmonary infection,including 49(62.82%)strains of gram-negative bacteria,25(32.05%)strains of gram-positive bacteria,and 4(5.13%)strains of fungi.There were significant differences in genotype frequencies of rs2305619 and rs1840680,and allele frequencies of rs1840680 among the three groups(P<0.05).The levels of serum PTX3 in the three groups were decreased successively in the infected group,the uninfected group and the control group(P<0.05).Multivariate logistic regression analysis showed that the course of diabetes,length of hospital stay,maintenance hemodialysis,renal function,serum PTX3 and PTX3 rs1840680 polymorphism were influencing factors for pulmonary infection in patients with DN(P<0.05).CONCLUSION The distribution of pathogenic bacteria in patients with DN complicated with pulmonary infection has certain characteristics.The course of diabetes,length of hospital stay,maintenance hemodialysis,renal function,PTX3 rs1840680 polymorphism and serum PTX3 level are influencing factors of pulmonary infection in patients with DN.