血液透析导管相关性血流感染病原菌与危险因素及TGF-β1/Smads通路的诊断价值

Pathogens and risk factor for catheter-related bloodstream infection in hemodialysis patients and diagnostic values of TGF-β1/Smads pathways

目的探讨血液透析患者导管相关性血流感染(CRBSI)病原菌特征、危险因素及转化生长因子-β1(TGF-β1)/Smads通路的诊断价值.方法选取2020年3月—2023年3月于锦州医科大学附属第一医院行血液透析的162例患者作为研究对象,根据其是否发生CRBSI分为感染组(n=51)和未感染组(n=111),统计感染现状及病原学分布,分析血液透析患者CRBSI的危险因素,比较两组患者血清中TGF-β1、Smad2、Smad3蛋白表达,分析TGF-β1、Smad2、Smad3单独及联合检测对血液透析患者CRBSI的诊断价值.结果162例行血液透析患者,发生CRBSI为51例(占31.48%);共培养出51株病原菌,金黄色葡萄球菌(27.45%)、溶血葡萄球菌(17.65%)、大肠埃希菌(15.69%)占比较高;血液透析患者CRBSI的危险因素为糖尿病、导管留置时间久、置管部位为股静脉、穿刺次数多、血清白蛋白水平低(P<0.05);与未感染组相比,感染组血清中TGF-β1、Smad2、Smad3蛋白水平高(P<0.05),三者联合检测对血液透析患者CRBSI的诊断曲线下面积(AUC)值高于单独检测(P<0.05),且联合检测的敏感度为92.16%,特异度为80.18%.结论血液透析患者CRBSI以金黄色葡萄球菌、溶血葡萄球菌、大肠埃希菌为主,与TGF-β1/Smads通路激活有关,TGF-β1、Smad2、Smad3联合检测对其诊断价值高.

OBJECTIVE To investigate the pathogens and risk factor for catheter-related bloodstream infection(CRBSI)in hemodialysis patients and diagnostic values of transforming growth factor-β1(TGF-β1)/Smads path-ways.METHODS A total of 162 patients undergoing hemodialysis in the First Affiliated Hospital of Jinzhou Medi-cal University from Mar 2020 to Mar 2023 were selected as the study objects,and divided into the infected group(n=51)and the uninfected group(n=111)according to whether they had CRBSI.The infection status and etio-logical distribution were analyzed,and the risk factors of CRBSI in hemodialysis patients were analyzed.The pro-tein expressions of TGF-β1,Smad2 and Smad3 in serum between the two groups were compared,and the diagnos-tic value of alone and combined detection of TGF-β1,Smad2 and Smad3 in CRBSI in hemodialysis patients was an-alyzed.RESULTS The CRBSI occurred in 51 cases of 162(31.48%)hemodialysis patients.A total of 51 strains of pathogenic bacteria were cultured,and Staphylococcus aureus(27.45%),Staphylococcus hemolyticus(17.65%)and Escherichia coli(15.69%)accounted for the higher proportions.The independent risk factors for CRBSI in hemodialysis patients were diabetes mellitus,long catheter indwelling time,femoral vein placement,high puncture times and low ser-um albumin level(P<0.05).Compared with the uninfected group,TGF-β1,Smad2 and Smad3 protein levels in serum were higher than those in the infected group(P<0.05).The area under the diagnostic curve(AUC)value of combined detection of TGF-β1,SMad2 and SMAD3 in the diagnosis of CRBSI in hemodialysis patients was higher than that of the individual detection(P<0.05),and the sensitivity and specificity of the combined detection was 92.16%and 80.18%,respectively.CONCLUSION S.aureus,S.hemolyticus and E.coli were the main CRBSI-related pathogens in he-modialysis patients.CRBSI can be associated with the activation of TGF-β1/Smads pathway,and the combined de-tection of TGF-β1,Smad2 and Smad3 has high diagnostic value.