心脏手术后医院感染的危险因素及其与TGF-β1/Smads信号通路的关联

Risk factors for nosocomial infection after cardiac surgery and their association with the TGF-β1/Smads signaling pathway

目的探讨心脏手术后医院感染的危险因素及其与转化生长因子-β1(TGF-β1)/Smads信号通路的关联.方法回顾性分析2022年3月-2023年3月四川省医学科学院/四川省人民医院/电子科技大学附属医院收治的心脏手术患者573例的临床资料,根据医院感染情况分为感染组(85例)和非感染组(488例);归纳心脏手术患者术后医院感染的危险因素;检测TGF-β1、Smad2、Smad3表达水平;比较两组TGF-β1、Smad2、Smad3表达水平;采用受试者工作特征(ROC)曲线分析TGF-β1、Smad2、Smad3单独及联合检测对心脏手术患者术后医院感染的诊断价值.结果手术时间、糖尿病、联用抗菌药物、二次手术、术后住院天数是心脏手术患者术后医院感染的危险因素(OR=1.912、1.984、2.356、1.996、2.128,P均<0.05);感染组TGF-β1、Smad2、Smad3水平均高于非感染组(P<0.05);绘制ROC曲线获得TGF-β1、Smad2、Smad3单独及联合检测诊断心脏手术患者术后医院感染的曲线下面积(AUC)分别为0.757、0.765、0.731和0.858,联合诊断的AUC高于各项单独检测(P<0.05),且联合检测的敏感度和特异度为67.10%,88.00%.结论心脏手术患者术后医院感染TGF-β1/Smads信号通路被激活;联合检测TGF-β1、Smad2、Smad3有助于诊断心脏手术后医院感染;临床可根据危险因素给予患者针对性治疗及干预措施,以降低心脏手术患者术后医院感染的发生风险.

OBJECTIVE To investigate the risk factors for postoperative nosocomial infection after cardiac surgery and their association with transforming growth factor beta 1(TGF-β1)/Smads signaling pathway.METHODS The clinical data of 573 patients undergoing cardiac surgery admitted to Sichuan Academy of Medical Sciences/Sichuan People's Hospital/University of Electronic Science and Technology of China from Mar.2022 to Mar.2023 were retrospectively analyzed,and they were divided into infected group(85 cases)and non-infected group(488 cases)according to nosocomial infection.The risk factors of postoperative nosocomial infection in patients with cardiac surgery were summarized.The expression levels of TGF-β1,Smad2 and Smad3 were detected.The expression lev-els of TGF-β1,Smad2 and Smad3 were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of TGF-β1,Smad2 and Smad3 alone and in combination for postoperative nosocomial infection in patients undergoing cardiac surgery.RESULTS The risk factors of postopera-tive nosocomial infection were operation time,diabetes mellitus,coadministration of antibiotics,second operation and length of hospitalization days(OR=1.912,1.984,2.356,1.996,2.128,all P<0.05).The expression levels of TGF-β1,Smad2 and Smad3 in the infected group were higher than those in the non-infected group(P<0.05).The area under the curve(AUC)of TGF-β1,Smad2,Smad3 alone and combined detection for the diagnosis of postoperative nosocomial infection in patients with cardiac surgery were 0.757,0.765,0.731,and 0.858,respec-tively.The AUC of combined diagnosis was higher than that of single detection(P<0.05),and the sensitivity and specificity of combined detection were 67.10%and 88.00%,respectively.CONCLUSION The TGF-β1/Smads sig-naling pathway was activated in patients with nosocomial infection after cardiac surgery.The combined detection of TGF-β1,Smad2 and Smad3 was helpful in the diagnosis of postoperative nosocomial infection in patients undergo-ing cardiac surgery.Clinical treatment and intervention measures could be tailored according to risk factors to re-duce the risk of postoperative nosocomial infection in cardiac surgery patients.