慢性肾衰竭维持性血液透析肺部感染病原菌及其影响因素

Pathogenic bacteria and influencing factors for pulmonary infection in chronic renal failure patients undergoing maintenance hemodialysis

目的分析慢性肾衰竭维持性血液透析(MHD)患者肺部感染病原菌特点、影响因素及Toll样受体4(TLR4)/核因子κB(NF-κB)信号通路变化.方法前瞻性纳入2018年1月—2022年7月南阳医专第一附属医院收治的慢性肾衰竭MHD患者350例,以研究对象肺部感染为依据,分为研究组(合并肺部感染,n=120)、对照组(未合并肺部感染,n=230);分析慢性肾衰竭MHD患者肺部感染的病原菌特点、两组临床资料(包括外周血单核细胞TLR4、NF-κB表达水平),通过Logistic回归分析法分析其影响因素.结果120例慢性肾衰竭MHD患者并发肺部感染共分离出病原菌155株,革兰阴性菌为主96株(61.94%);年龄升高、合并糖尿病、血清C-反应蛋白(CRP)水平升高、外周血单核细胞TLR-4表达水平升高、外周血单核细胞NF-κB表达水平升高为慢性肾衰竭MHD患者肺部感染的危险因素(P<0.05);血清血红蛋白(Hb)水平升高为慢性肾衰竭MHD患者肺部感染的保护因素(P<0.05).结论慢性肾衰竭MHD患者肺部感染的病原菌分布以革兰阴性菌为主,TLR4/NF-κB信号通路参与肺部感染的发生,其危险因素较多,可据此采取干预措施.

OBJECTIVE To analyze the characteristics of pathogenic bacteria,influencing factors and changes of Toll-like receptor 4(TLR4)/nuclear factorκB(NF-κB)signaling pathway in patients with chronic renal failure and maintenance hemodialysis(MHD).METHODS A total of 350 patients with chronic renal failure MHD admit-ted to the First Affiliated Hospital of Nanyang Medical College from Jan 2018 to Jul 2022 were prospectively in-cluded.They were divided into the study group(with lung infection,n=120)and the control group(without lung infection,n=230)according to the incidence of lung infection.The pathogenic bacteria characteristics of lung in-fection in patients with chronic renal failure MHD were analyzed,and the clinical data,the expression levels of TLR4 and NF-κB between the two groups were analyzed and compared.The influencing factors of lung infection in patients with chronic renal failure MHD were analyzed by multivariate logistic regression analysis.RESULTS A to-tal of 155 pathogenic bacteria were isolated from 120 patients with chronic renal failure and pulmonary infection,including 96 strains of gram-negative bacteria,accounting for 61.94%.The results of logistic regression analysis showed that the risk factors of pulmonary infection in patients with chronic renal failure undergoing MHD were in-creasing age,diabetes mellitus,high serum level of C-reactive protein(CRP),high levels of TLR-4 and NF-κB in peripheral blood monocyte(P<0.05).Elevated serum level of hemoglobin(Hb)was a protective factor for pul-monary infection in patients with chronic renal failure undergoing MHD(P<0.05).CONCLUSION The main pathogens of pulmonary infection in patients with chronic renal failure MHD were gram-negative bacteria.TLR4/NF-κB signaling pathway is involved in the occurrence of pulmonary infection.There are many risk factors,so in-tervention measures could be taken accordingly.