开放性骨折患者清创前、后创面细菌计数、NF-κB/JNK/PI3K炎症信号通路相关因子对骨感染的诊断价值

Diagnostic value of wound bacterial count and NF-κB/JNK/PI3K inflammatory signaling pathway-related factors on bone infection in patients with open fracture before and after debridement

目的探讨开放性骨折患者清创前、后创面细菌计数和核因子-κB(NF-κB)/c-Jun N-末端激酶(JNK)/磷酸酰肌醇3-激酶(PI3K)炎症信号通路相关因子对骨感染的诊断价值。方法选取2020年1月至2023年8月达州市中心医院收治的开放性骨折患者257例,根据是否发生骨感染分为感染组(31例)和无感染组(226例)。比较两组基线资料及清创前、后创面细菌计数及NF-κB信使RNA(mRNA)、JNK mRNA、PI3K mRNA水平;采用Pearson相关分析开放性骨折患者NF-κB mRNA、JNK mRNA、PI3K mRNA水平与创面细菌计数的相关性;绘制受试者工作特征(ROC)曲线分析创面细菌计数、NF-κB mRNA、JNK mRNA、PI3K mRNA对开放性骨折患者发生骨感染的诊断价值;采用危险度分析不同创面细菌计数、NF-κB mRNA、JNK mRNA、PI3K mRNA表达开放性骨折患者发生骨感染的情况。结果感染组和无感染组Gustilo分型、受伤至手术时间、骨折固定方式比例、合并糖尿病比例比较,差异均有统计学意义(P<0.05);两组清创后创面细菌计数及NF-κB mRNA、JNK mRNA、PI3K mRNA水平低于清创前,差异均有统计学意义(P<0.05);清创后,感染组创面细菌计数及NF-κB mRNA、JNK mRNA、PI3K mRNA水平高于无感染组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,清创前、后开放性骨折患者NF-κB mRNA、JNK mRNA、PI3K mRNA水平与创面细菌计数均呈正相关(P<0.05)。ROC曲线结果显示,创面细菌计数、NF-κB mRNA、JNK mRNA、PI3K mRNA诊断开放性骨折患者骨感染的曲线下面积(AUC)分别为0.807、0.742、0.807、0.766,灵敏度分别为87.10%、61.29%、61.29%、67.74%,特异度分别为65.04%、88.63%、93.36%、74.41%,以上4项指标联合诊断骨感染的AUC为0.924,灵敏度为83.87%;特异度为89.10%。创面细菌计数及NF-κB mRNA、JNK mRNA、PI3K mRNA表达阳性患者骨感染的相对风险是阴性患者的9.616、7.459、10.385、4.732倍,差异均有统计学意义(P<0.05)。结论创面细菌计数、NF-κB/JNK/PI3K炎症信号通路相关因子水平在开放性骨折并发骨感染患者创面组织中升高,上述指标联合检测对骨感染具有一定诊断价值,可作为临床诊断骨感染的辅助指标。

Objective To investigate the value of wound bacterial count and nuclear factor-κB(NF-κB)/c-Jun N-terminal kinase(JNK)/phosphoinositol 3-kinase(PI3K)inflammatory signaling pathway-related factors in predicting bone infection in patients with open fracture before and after debridement.Methods A total of 257 patients with open fracture enrolled in Dazhou Central Hospital from January 2020 to August 2023 were selected and divided into infected group(31 cases)and non-infected group(226 cases)according to whether or not bone infection occurred.Baseline data,wound bacterial count and NF-κB messenger RNA(mRNA),JNK mRNA and PI3K mRNA levels before and after debridement were compared between the two groups;Pearson′s correlation was used to analyze the correlation of NF-κB mRNA,JNK mRNA and PI3K mRNA levels with bacterial count;receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of wound bacterial count,NF-κB mRNA,JNK mRNA and PI3K mRNA on bone infection;the risk analysis was used to analyze the relative risk of bone infection in patients with different wound bacterial count,NF-κB mRNA,JNKmRNA and PI3K mRNA.Results Gustilo classification,time from injury to operation,proportion of different fixation method,proportion of combined diabetes mellitus between the infected group and the non-infected group showed statistically significant differences(P<0.05).Wound bacterial count and NF-κB mRNA,JNK mRNA,PI3K mRNA levels in both groups after debridement were lower than those before debridement,and the differences were statistically significant(P<0.05);after debridement,the bacterial count and NF-κB mRNA,JNK mRNA,PI3K mRNA levels in the infected group were higher than those in the non-infected group,with statistically significant differences(P<0.05).The results of the Pearson′s correlation analysis showed that there was a positive correlation of NF-κB mRNA,JNK mRNA,PI3K mRNA levels with bacterial counts before and after debridement(P<0.05).The results of ROC curve showed that the area under the curves(AUCs)of wound bacterial count,NF-κB mRNA,JNK mRNA and PI3K mRNA for predicting bone infection were 0.807,0.742,0.807 and 0.766,respectively,with sensitivity of 87.10%,61.29%,61.29%,67.74%,respectively,with specificity of 65.04%,88.63%,93.36%,74.41%,respectively,and the AUC of the above four indicators combined to predict bone infection was 0.924,with sensitivity of 83.87%and specificity of 89.10%.The relative risk of bone infection in patients with positive wound bacterial count and NF-κB mRNA,JNK mRNA,PI3K mRNA was 9.616,7.459,10.385 times and 4.732 times higher than that in negative patients,and the differences were statistically significant(P<0.05).Conclusion Wound bacterial count and NF-κB/JNK/PI3K inflammatory signaling pathway-related factors are up-regulated in the wound tissue of patients with open fracture complicated with bone infection,and the combined detection has a certain predictive value for bone infection,which can be used as auxiliary index for clinical prediction of bone infection.