糖尿病足感染中血清TLR-9和Cys-C表达及危险因素分析

Expression of serum TLR⁃9 and Cys⁃C in diabetic foot infection and analysis of the risk factors

目的探讨血清Toll样受体9(TLR-9)、半胱氨酸蛋白酶抑制剂C(Cys-C)在糖尿病足感染中的诊断效能,并分析危险因素。方法选择2016年1月-2023年3月芜湖市中医医院收治的糖尿病足患者80例,根据是否合并感染分为感染组22例、未感染组58例。比较感染组与未感染组血清TLR-9、Cys-C水平,采用多因素logistic分析糖尿病足患者合并感染的危险因素,并使用受试者工作特征(ROC)曲线分析血清TLR-9、Cys-C水平对糖尿病足合并感染的诊断效能。结果单因素分析显示,两组年龄、性别、身体质量指数、病程、高血压、冠心病比较差异均无统计学意义(P均>0.05);两组溃疡数、合并血管并发症、合并骨髓炎比较差异均有统计学意义(χ^(2)=12.406、7.918、11.349,P均<0.05)。感染组血清TLR-9、Cys-C水平均显著高于未感染组,差异均有统计学意义(t=12.508、3.916,P均<0.05)。多因素logistic回归分析显示,溃疡数、合并血管并发症、合并骨髓炎、血清TLR-9、Cys-C水平均为导致糖尿病足合并感染的危险因素(P均<0.05)。ROC结果显示,血清TLR-9预测糖尿病足合并感染的曲线下面积(AUC)为0.834,灵敏度为86.70%,特异度为91.20%;Cys-C预测糖尿病足合并感染的AUC为0.875,灵敏度为88.60%,特异度为84.40%;联合检测预测糖尿病足合并感染的AUC为0.926,灵敏度为96.70%,特异度为97.00%;联合检测较单独检测敏感度和特异度更高(P均<0.05)。结论糖尿病足合并感染患者感染的危险因素较多,联合检测血清TLR-9、Cys-C水平具有较高的预测价值,临床上应予以密切关注,以降低感染发生率。

Objective To study the expression of serum toll⁃like receptor 9(TLR⁃9),cystatin C(Cys⁃C)and the risk factors in diabetic foot infection.Methods A total of 80 patients with diabetic foot admitted to the Wuhu Hospital of Traditional Chinese Medicine from January 2016 to March 2023 were selected and divided into infected group(22 cases)and uninfected group(58 cases)according to whether the patients were co⁃infected.Serum TLR⁃9 and Cys⁃C levels were compared between infected group and uninfected group,and the risk factors of diabetic foot co⁃infected patients were analyzed by multivariate logistic analysis.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of serum TLR⁃9 and Cys⁃C levels in diabetic foot infection.Results Univariate analysis showed no significant differences in age,gender,body mass index,course of disease,hypertension and coronary heart disease between the two groups(P>0.05).There were significant differences in the number of ulcers,vascular complications and osteomyelitis between the two groups(χ^(2)=12.406,7.918,11.349;all P<0.05).Serum levels of TLR⁃9 and Cys⁃C in infected group were significantly higher than those in uninfected group(t=12.508,3.916;all P<0.05).Multivariate logistic regression analysis showed that the number of ulcers,vascular complications,osteomyelitis,serum TLR⁃9 and Cys⁃C levels were all risk factors for diabetic foot infection(P<0.05).ROC results showed that the area under the curve(AUC)of serum TLR⁃9 predicting diabetic foot co⁃infection was 0.834,with the sensitivity of 86.70%,and the specificity of 91.20%;the AUC of Cys⁃C predicting diabetic foot co⁃infection was 0.875,with the sensitivity of 88.60%,the specificity of 84.40%.The AUC of combined detection for predicting diabetic foot co⁃infection was 0.926,with the sensitivity of 96.70%,and the specificity of 97.00%.Combined detection had higher sensitivity and specificity than single detection(all P<0.05).Conclusion There were many risk factors of infection in patients with diabetic foot co⁃infection,and the combined detection of serum TLR⁃9 and Cys⁃C levels had high predictive value,which should be paid close attention in clinical practice to reduce the incidence of infection.