缺血性脑卒中患者肺部感染病原菌及其血清HIF-1α、HMGB1和TLR4/NF-κB信号通路的预测价值

Pathogenesis of pulmonary infection in ischemic stroke patients and its predictive value of serum HIF-1α,HMGB1 and TLR4/NF-κB signaling pathway

目的研究缺血性脑卒中患者肺部感染病原菌及其血清缺氧诱导因子-1α(HIF-1α)、高迁移率族蛋白B1(HMGB1)和Toll样受体4(TLR4)/核因子-κB(NF-κB)信号通路水平。方法选择2020年6月-2023年6月常熟市第二人民医院收治的80例缺血性脑卒中患者,根据肺部感染情况分为感染组(33例)和非感染组(47例),统计缺血性脑卒中患者肺部感染病原菌特点,比较两组血清HIF-1α、HMGB1和TLR4/NF-κB信号通路指标水平,分析血清HIF-1α、HMGB1和TLR4/NF-κB信号通路对缺血性脑卒中患者肺部感染的预测价值。结果33例缺血性脑卒中肺部感染患者共培养分离病原菌45株,其中革兰阴性菌27株,革兰阳性菌16株,真菌2株,以铜绿假单胞菌、表皮葡萄球菌、肺炎克雷伯菌为主;感染组血清HIF-1α、HMGB1、TLR4和NF-κB分别为(53.81±9.75)ng/ml、(8.69±2.44)ng/ml、3.07±0.87和2.14±0.72高于非感染组(P<0.05);血清HIF-1α、HMGB1和TLR4/NF-κB信号通路指标联合预测缺血性脑卒中患者肺部感染的曲线下面积(AUC)为0.898高于单独检测(P<0.05)。结论缺血性脑卒中患者肺部感染主要感染病原菌种类较多,血清HIF-1α、HMGB1和TLR4/NF-κB信号通路指标联合的预测价值较好。

OBJECTIVE To investigate the pathogenesis of pulmonary infection in ischemic stroke patients and its predictive value of serum hypoxia-inducible factor-1α(HIF-1a),high mobility group protein B1(HMGB1)and Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway.METHODS A total of 80 patients with ischemic stroke admitted to the No.2 People's Hospital of Changshu from Jun.2020 to Jun.2023 were selected and divided into infection group(33 cases)and non-infection group(47 cases)according to the pulmonary infection.The pathogenesis characteristics of pulmonary infection in ischemic stroke patients were statistically analyzed,the levels of serum HIF-1α,HMGB1 and TLR4/NF-κB signaling pathways were compared between the two groups,and the predictive value of serum HIF-1α,HMGB1 and TLR4/NF-κB signaling pathway for pulmo-nary infection in ischemic stroke patients was analyzed.RESULTS A total of 45 strains of pathogenic bacteria were isolated from 33 patients with pulmonary infection after ischemic stroke,including 27 strains of gram-negative bacteria,16 strains of grampositive bacteria and 2 strains of fungi,mainly Pseudomonas aeruginosa,Staphylococcus epidermidis and Klebsiella pneumoniae.The serum levels of HIF-1α,HMGBl,TLR4,and NF-κB in the infection group were(53.81±9.75)ng/ml,(8.69±2.44)ng/ml,3.07±0.87 and 2.14±0.72,respectively,higher than those in the non-infection group(P<0.05).The area under the curve(AUC)of combined detection of serum HIF-1α,HMGBI and TLR4/NF-κB signaling pathway indexes for the prediction of pulmonary infection in ischemic stroke patients was 0.898,higher than that of single detection(P<0.05).CONCLUSION Pulmonary infection in ischemic stroke patients had a wide range of major infectious pathogens,and the combined detetion of serum HIF-1α,HMGBl and TLR4/NF-κB signaling pathway had a better predictive value.