脊柱外科长期留置导尿管尿路感染与膀胱冲洗频率的关系及Wntβ-catenin通路基因表达

Relationship between urinary tract infection and frequency of bladder irrigation and expression of Wnt/β-catenin singling pathway gene in long-term urinary catheter indwelling patients of sprinal surgery department

目的探究脊柱外科长期留置导尿管患者尿路感染与膀胱冲洗频率的关系,分析尿路感染对患者Wnt/β-catenin信号通路基因表达水平的影响。方法选取2018年6月-2021年6月湖北医药学院附属医院脊柱外科因脊髓损伤需长期留置导尿管患者100例,根据冲洗频率分为A组(冲洗频率为1次/d)34例、B组(冲洗频率为2次/周)35例和C组(不冲洗,定期更换无菌密闭式尿袋)31例,分别于置管后3 d、7 d、14 d和21 d统计各组尿路感染发生率,分析感染病原学特点,实时荧光定量聚合酶链法检测外周血Wnt/β-catenin通路基因相对表达量。结果置管后7 d、14 d和21 d,B组尿路感染发生率低于A组、C组(P<0.05);21 d后共有33例患者发生尿路感染,共检出病原菌48株,其中革兰阴性菌34株(70.83%)、革兰阳性菌14株(29.17%);感染组患者外周血Wnt1、β-catenin基因相对表达量均高于非感染组(P<0.05)。结论脊柱外科长期留置导尿管患者尿路感染病原菌以革兰阴性菌为主,感染病原菌可能通过Wnt/β-catenin通路参与尿路感染的发生发展;膀胱冲洗可降低患者的尿路感染发生率,冲洗频率以2次/周为宜。

OBJECTIVE To explore the relationship between the urinary tract infection and the frequency of bladder irrigation of spinal surgery department patients with long-term urinary catheter indwelling and observe the impact of urinary tract infection on the expression level of Wnt/β-catenin signaling pathway gene.METHODS A total of 100 patients who needed to be treated with long-term urinary catheter indwelling due to spinal cord injury in spinal surgery department of the Affiliated Hospital of Hubei University of Medicine from Jun 2018 to Jun 2021 were enrolled in the study and divided into the group A with 34 cases(the frequency of irrigation once per day),the group B with 35 cases(the frequency of irrigation twice per week)and the group C with 31 cases(without irrigation,regular change of aseptic closed urine bag)according to the frequency of irrigation.The incidence of urinary trac infection of the three groups was statistically analyzed after the catheterization for 3,7,14 and 21 days,the etiological characteristics of the infection were analyzed,and the relative expression levels of Wnt/β-catenin pathway genes in peripheral blood were detected by real-time fluorescent quantitative polymerase chain reaction.RESULTS The incidence of urinary tract infection was lower in the group B than in the group A and the group C after the catheterization for 7,14 and 21 days(P<0.05).Totally 33 patients had urinary tract infection after the catheterization for 21 days.A total of 48 strains of pathogens were isolated,34(70.83%)of which were gram-negative bacteria,and 14(29.17%)were gram-positive bacteria.The relative expression levels of peripheral blood Wnt1 andβ-catenin genes of the patients with infection were higher than those of the patients without infection(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the long-term urinary catheter indwelling patients with urinary tract infection.The pathogens may get involved in the occurrence and development of urinary tract infection by Wnt/β-catenin pathway.The bladder irrigation can reduce the incidence of urinary tract infection,and twice per week is an appropriate frequency of bladder irrigation.