四肢开放性骨折合并感染病原菌和sTREM-1、Th1/Th2细胞因子及NLRP3信号通路

sTREM-1,Th1/Th2 cytokines and NLRP3 signal pathway in patients with open fracture of limbs combined with infection and pathogens

目的探讨四肢开放性骨折合并感染患者可溶性髓系细胞触发受体1(sTREM-1)、辅助性T细胞亚群1/2(Th1/Th2)细胞因子及Nod样受体蛋白3(NLRP3)信号通路。方法选取2020年8月-2023年8月潍坊市益都中心医院收治的102例四肢开放性骨折合并感染患者(研究组)和108例四肢开放性骨折未合并感染患者(对照组),分析病原菌及耐药性,比较两组血清sTREM-1、NLRP3、半胱氨酸天冬氨酸蛋白酶1(Caspase-1)表达,分析血清sTREM-1、外周血NLRP3、Caspase-1对四肢开放性骨折患者合并感染的诊断价值。结果研究组患者血清Th1、Th1/Th2分别为(9.95±2.24)%、0.68±0.07低于对照组,而血清Th2为(14.61±4.03)%高于对照组(P<0.05);102例四肢开放性骨折合并感染患者,检测出108株病原菌,主要为革兰阴性菌中的铜绿假单胞菌和革兰阳性菌中的金黄色葡萄球菌;铜绿假单胞菌对阿米星卡、庆大霉素较耐药;金黄色葡萄球菌对红霉素、青霉素较耐药;研究组血清sTREM-1、NLRP3和Caspase-1水平分别为(67.68±20.97)pg/ml、2.01±0.65和2.12±0.69高于对照组(P<0.05);血清sTREM-1、外周血NLRP3、Caspase-1水平联合检测对四肢开放性骨折合并感染患者的诊断曲线下面积(AUC)为0.945高于单独检测(P<0.05),且联合检测的敏感度为88.24%,特异度为92.59%。结论四肢开放性骨折合并感染患者主要感染的病原菌为革兰阴性菌,各病原菌耐药性有差异,对常用抗菌药物耐药性高。四肢开放性骨折合并感染与血清sTREM-1高表达及Th1/Th2失衡相关,且NLRP3通路活化,血清sTREM-1、外周血NLRP3、Caspase-1联合检测对四肢开放性骨折合并感染诊断价值高。

OBJECTIVE To investigate soluble myeloid trigger receptor 1(sTREM-1),helper T cell subpopulation 1/2(Th1/Th2)cytokines and NOD-like receptor protein 3(NLRP3)signal pathway in patients with open fracture of limbs combined with infection.METHODS A total of 102 patients with open fracture of limbs combined with infection(the study group)and 1o8 patients with open fracture of limbs without infection(the control group)admitted to Yidu Central Hospital from Aug.2020 to Aug.2023 were selected,the pathogenic bacteria and drug resistance were analyzed.The expression of serum sTREM-1,NLRP3 and Caspase-1 in the two groups were compared,and the diagnostic value of serum sTREM-1,peripheral blood NLRP3 and Caspase-1 for combined infections in patients with open fracture of limbs was analyzed.RESULTS The serum Thl and Th1/Th2 of patients in the study group were(9.95±2.24)%and 0.68±0.07,respectively,lower than those of the control group,while the serum Th2 was(14.61±4.03)%,higher than those of the control group(P<0.05).In 102 patients with open fracture of limbs combined with infection,1o8 strains of pathogenic bacteria were detected,mainly Pseudomonas aeruginosa of gram-negative bacteria and Staphylococcus aureus of gram-positive bacteria.Pseudomonas aeruginosa was more resistant to amicinka and gentamicin.Staphylococcus aureus was more resistant to erythromycin and penicillin.The serum levels of sTREM-1,NLRP3,and Caspase-1 in the study group were(67.68±20.97)pg/ml,2.01±0.65,and 2.12±0.69,respectively,higher than those in the control group(P<0.05).The area under the diagnostic curve(AUC)of serum sTREM-1,peripheral blood NLRP3 and Caspase-lcombined detection was 0.945,higher than that of single detection in patients with open limb fractures combined with infection(P<0.05),and the sensitivity and specificity of combined detection were 88.24%and 92.59%,respectively.CONCLUSIONS The main pathogenic bacteria in patients with open fracture of limbs combined with infection were gram-negative bacteria,and there were differences in drug resistance among pathogens,with high resistance to commonly used antimicrobial drugs.Combined infection of open fracture of limbs was associated with high serum sTREM-1 expression and Th1/Th2 imbalance,and the NLRP3 pathway was activated.The combined detection of serum sTREM-1,peripheral blood NLRP3 and Caspase-1 was of high value in the diagnosis of combined infection ofopen fractureof extremities.