口腔鳞癌术后口腔感染的危险因素及TLR4/NF-κB通路活化状态

Risk factors for postoperative oral infection and activation status of TLR4/NF-κB of patients with oral squamous cell carcinoma

目的探究口腔鳞癌(OSCC)患者术后口腔感染现况、危险因素及Toll样受体4(TLR4)/核转录因子-κB(NF-κB)信号通路的表达。方法选取湖州市第一人民医院2018年1月-2022年12月收治的116例OSCC患者,根据术后是否发生口腔感染,将其分为感染组32例和非感染组84例,统计感染病原菌分布特点;多因素Logistic回归分析OSCC患者术后发生口腔感染的危险因素;比较两组TLR4/NF-κB信号通路相关因子表达水平。结果116例OSCC患者术后发生口腔感染32例,口腔感染发生率为27.59%;感染组共检出33株病原菌,12株革兰阴性菌,占比36.36%,21株革兰阳性菌,占比63.64%;多因素Logistic分析结果显示,手术时间≥6 h、有糖尿病、预防性使用抗菌药物是OSCC患者术后发生口腔感染的危险因素(OR=2.282、2.117、2.416,P<0.05);感染组患者血清IL-6、TNF-α表达水平及TLR4、NF-κB mRNA相对表达量均高于非感染组(P<0.05)。结论OSCC患者术后口腔感染主要是革兰阳性菌,手术时间≥6 h、有糖尿病、预防性使用抗菌药物与OSCC患者术后口腔感染发生密切相关,术后口腔感染患者TLR4/NF-κB信号通路相关因子表达上调。

OBJECTIVE To explore the prevalence of postoperative oral infection,risk factors and expressions of Toll-like receptor 4(TLR4)/nuclear transcription factor-κB(NF-κB)signaling pathways in the patients with oral squamous cell carcinoma(OSCC).METHODS Totally 116 patients with OSCC who were treated in Huzhou First People′s Hospital from Jan 2018 to Dec 2022 were enrolled in the study and were divided in to the infection group with 32 cases and the non-infection group with 84 cases according to the status of postoperative oral infection.The distribution of pathogens was statistically analyzed,multivariate logistic regression analysis was performed for the risk factors for the postoperative oral infection,and the expression levels of TLR4/NF-κB signaling pathway-related factors were compared between the two groups.RESULTS Of the 116 patients with OSCC,32 had postoperative oral infection,with the incidence of oral infection 27.59%.Totally 33 strains of pathogens were isolated from the infection group,12(36.36%)of which were gram-negative bacteria,21(63.64%)were gram-positive bacteria.The result of multivariate logistic analysis showed that operation duration no less than 6 hours,diabetes mellitus and prophylactic use of antibiotics were the risk factors for the postoperative oral infection in the OSCC patients(OR=2.282,2.117,2.416,P<0.05).The expression levels of serum IL-6,TNF-αand relative expression levels of TLR4 and NF-κB mRNA were significantly higher in the infection group than in the non-infection group(P<0.05).CONCLUSION The gram-positive bacteria are dominant among the pathogens isolated from the OSCC patients with postoperative oral infection.The postoperative oral infection in the OSCC patients is closely associated with the operation duration no less than 6 hours,diabetes mellitus and prophylactic use of antibiotics,and the patients with postoperative oral infection show the upregulation of TLR4/NF-κB signaling pathway-related factors.