循环游离DNA联合16S rRNA基因检测在糖尿病烧伤脓毒症早期诊断中的作用  

Value of circulating free DNA combined with 16S rRNA gene detection in early diagnosis of diabetic burn sepsis

作　　者：郑媛媛[1] 张良[1] 马国英[1] 董春忠[1] 王加芬[1] 王月玲 ZHENG Yuan-yuan;ZHANG Liang;MA Guo-ying;DONG Chun-zhong;WANG Jia-fen;WANG Yue-ling(Binzhou People Undefineds Hospital,Binzhou,Shandong 256600,China)

机构地区：[1]山东省滨州市人民医院检验科

出　　处：《中华医院感染学杂志》2019年第21期3284-3287,3292,共5页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展计划基金资助项目(2014WS0081)

摘　　要：目的探讨循环游离DNA(cf-DNA)联合16S核糖体RNA(16S rRNA)基因检测在糖尿病烧伤脓毒症患者早期诊断中的作用。方法选择2016年3月-2018年5月山东省滨州市人民医院烧伤科收治的糖尿病烧伤可疑脓毒症患者65例,采取常规血培养及16S rRNA基因检测PCR法进行细菌分离鉴定,并检测患者外周血炎症指标及血糖变化。分析PCR、血培养结果与各指标关系。结果16S rRNA基因检测PCR法检出65例标本,阳性30例,阳性率46.15%,血培养阳性18例,阳性率27.69%(P<0.05);PCR法检测所需时间低于常规血培养(P<0.05)。PCR法检出革兰阴性菌19株(占63.33%)、革兰阳性菌11株(占36.67%);血培养检出革兰阴性菌13株(占72.22%)、革兰阳性菌5株(占27.78%)。PCR检测阳性患者cf-DNA、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、空腹血糖(FBG)以及餐后2 h血糖(2h PG)均高于PCR阴性患者(P<0.05)。患者cf-DNA水平与外周血CRP、TNF-α、IL-6水平呈正相关关系(P<0.05)。血培养阳性患者cf-DNA、CRP、TNF-α、IL-6、FBG以及2hPG均高于血培养阴性患者(P<0.05)。结论16S rRNA基因PCR检测可快速诊断糖尿病烧伤脓毒血症患者感染病原菌,联合cf-DNA运用,有助于糖尿病烧伤脓毒血症患者的早期诊断。OBJECTIVE To explore the value of circulating free DNA(cf-DNA)combined with 16 S ribosomal RNA(16 S rRNA)gene detection in early diagnosis of patientsd with diabetic burn sepsis.METHODS A total of 65 diabetic burn patients who had suspected sepsis and were treated in burns department of Binzhou People Undefineds Hospital from Mar.2016 to May 2018 were enrolled in the study,the conventional blood culture was performed and the 16 S rRNA gene detection was carried out for identification of bacteria by PCR.The correlation between PCR,result of blood culture and the indexes was observed.RESULTS The 16 S rRNA gene detection showed that 30 of 65 specimens were positive,with the positive rate 46.15%;18 patients were positive for blood culture,with the positive rate 27.69%(P<0.05).The time of the PCR detection was significantly shorter than that of the conventional blood culture(P<0.05).Totally 19(63.33%)strains of gram-negative bacteria and 11(36.67%)strains of gram-positive bacteria were isolated by PCR;totally 13(72.22%)strains of gram-negative bacteria and 5(27.78%)strains of gram-positive bacteria were isolated by blood culture.The levels of cf-DNA,C-reactive protein(CRP),tumor necrosis factor(TNF-α),interleukin-6(IL-6),fasting blood glucose(FBG)and 2 h postprandial blood glucose(2 h PG)of the PCR-positive patients were significantly higher than those of the PCR-negative patients(P<0.05).The cf-DNA level was positively correlated with the levels of peripheral blood CRP,TNF-αand IL-6(P<0.05).The levels of cf-DNA,CRP,TNF-α,IL-6,FBG and 2 hPG of the patients positive for blood culture were significantly higher than those of the patients negative for blood culture(P<0.05).CONCLUSION The PCR detection of 16 S rRNA gene may rapidly identify the pathogens causing infection in the diabetic burn sepsis patients,and its combination with cf-DNA may facilitate the early diagnosis of the diabetic burn sepsis.

关 键 词：循环游离DNA 16S rRNA 糖尿病 烧伤 脓毒症 

分 类 号：R446[医药卫生—诊断学]