重症颅脑损伤肺部感染危险因素及其与丝裂原活化蛋白激酶信号通路的关联

Risk factors for pulmonary infection and association with mitogen-activated protein kinases signaling pathways of patients with severe craniocerebral injury

目的 探讨重症颅脑损伤患者肺部感染危险因素及其与丝裂原活化蛋白激酶(MAPK)信号通路的关联。方法 选取桐乡市第二人民医院2020年2月-2023年2月收治的120例重症颅脑损伤患者为研究对象,根据肺部感染情况分为感染组和非感染组,分别为55例和65例。通过Logistic法对重症颅脑损伤患者肺部感染危险因素进行分析;采用实时荧光定量聚合酶链式反应(RT-q PCR)检测MAPK通路关键因子表达;比较两组p38、细胞外调节蛋白激酶(ERK)、应激活化蛋白激酶(JNK)水平;通过受试者工作特征(ROC)曲线对p38、ERK、JNK单独及联合检测重症颅脑损伤患者肺部感染诊断价值进行分析。结果 重症颅脑损伤患者肺部感染发生率为45.83%(55/120);年龄≥60岁、合并糖尿病、有机械通气、有气管切开术、血清白蛋白(ALB)水平低均是重症颅脑损伤患者肺部感染的危险因素(P<0.05);感染组p38、ERK、JNK水平高于非感染组(P<0.05);p38、ERK、JNK水平联合检测诊断重症颅脑损伤患者肺部感染的曲线下面积(AUC)较单独检测更高(P<0.05),敏感度和特异度高。结论 重症颅脑损伤患者肺部感染发生率高,且感染发生后MAPK通路被激活;联合检测p38、ERK、JNK有助于诊断重症颅脑损伤患者肺部感染;重症颅脑损伤患者肺部感染与患者年龄、合并糖尿病、机械通气、气管切开术、血清ALB水平相关。

OBJECTIVE To explore the association between pulmonary infection and mitogen-activated protein kina-ses(MAPK)signaling pathways of the patients with severe craniocerebral injury and analyze the risk factors for the pulmonary infection.METHODS A total of 120 patients with severe craniocerebral injury who were treated in Tongxiang Second People's Hospital from Feb 2020 to Feb 2023 were recruited as the research subjects and were divided into the infection group with 55 cases and the non-infection group with 65 cases according to the status of pulmonary infection.Logistic analysis was performed for the risk factors for the pulmonary infection in the pa-tients with severe craniocerebral injury.The expressions of key factors of MAPK pathways were detected by real-time fluorescent quantitative polymerase chain reaction(RT-qPCR).The levels of p38,extracellular regulated protein kinases(ERK)and stress-activated protein kinase(JNK)were compared between the two groups.The values of p38,ERK,JNK and the joint detection in diagnosis of the pulmonary infection were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The incidence of pulmonary infection was 45.83%(55/120)among the patients with severe craniocerebral injury.The no less than 60 years of age,complication with diabetes mellitus,mechanical ventilation,tracheotomy and low level of serum albumin were the risk factors for the pulmonary infection in the patients with severe craniocerebral injury(P<0.05).The levels of p38,ERK and JNK of the infection group were significantly higher than those of the non-infection group(P<0.05).The area un-der curve(AUC)of the joint detection of p38,ERK and JNK was significantly higher than that of the single de-tection in diagnosis of the pulmonary infection in the patients with severe craniocerebral injury(P<0.05),the sen-sitivity and specificity were high.CONCLUSION The incidence of pulmonary infection is high among the patients with severe craniocerebral injury,and the MAPK pathways are activated after the infection occurs.The joint de-tection of p38,ERK and JNK may facilitate the diagnosis of pulmonary infection.The pulmonary infection in the patients with severe craniocerebral injury is associated with the age,complication with diabetes mellitus,mechani-cal ventilation,tracheotomy and serum ALB.