血液透析患者血管通路感染TLR4基因多态性及外周血NLR和PLR与PCT对感染的诊断价值  

TLR4 gene polymorphisms and diagnostic value of peripheral blood NLR, PLR and PCT in vascular access infections in hemodialysis patients

作　　者：周国琴[1] 陶科颖[2] 朱红霞[3] 俞铭儿[4] 方瑜 ZHOU Guo-qin;TAO Ke-ying;ZHU Hong-xia;YU Ming-er;FANG Yu(The First People's Hospital of Xiaoshan District,Hangzhou City,Hangzhou,Zhejiang 311200,China)

机构地区：[1]杭州市萧山区第一人民医院全科医学科,浙江杭州311200 [2]杭州市萧山区第一人民医院心胸血管外科,浙江杭州311200 [3]杭州市萧山区第一人民医院肾内科,浙江杭州311200 [4]杭州市萧山区第一人民医院血透室,浙江杭州311200

出　　处：《中华医院感染学杂志》2021年第12期1840-1845,共6页Chinese Journal of Nosocomiology

基　　金：杭州市卫生科技计划基金资助项目(2018B017)。

摘　　要：目的探究血液透析患者血管通路感染TLR4基因型分布及外周血中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)及降钙素原(PCT)水平对感染的诊断价值。方法选择2014年2月-2019年10月杭州市萧山区第一人民医院发生血管通路感染的110例血液透析患者设为感染组,另选取89例同期住院期间血液透析未发生血管通路感染的患者为非感染组。感染组患者进行病原菌培养及致病菌耐药性分析,检测两组TLR4基因多态性,在疑似感染当日检测NLR、PLR、PCT水平。结果110例感染组患者共培养分离出128株病原菌,其中革兰阴性菌78株(60.94%),革兰阳性菌47株(36.72%),另有真菌3株(2.34%)。革兰阴性菌对哌拉西林、氨苄西林、头孢噻肟、头孢克肟、氨苄西林-舒巴坦耐药率较高,对美罗培南、亚胺培南等药物耐药性较低;革兰阳性菌对红霉素、克林霉素、环丙沙星、庆大霉素、左氧氟沙星等药物耐药率较高,对利奈唑胺、万古霉素等药物耐药性较低。哈代温伯格平衡检验提示,TLR4基因rs11536889位点在不同组间均符合哈代温伯格平衡;TLR4基因rs11536889位点与感染发生相关(P<0.05)。全身血流感染组患者外周血NLR、PLR、PCT水平高于局部感染组及未感染组(P<0.05)。外周血NLR、PLR、PCT水平单独诊断血管通路血流感染的曲线下面积(AUC)分别为0.813、0.797、0.855,其中PCT诊断AUC最大,当截点值为2.75 ng/ml时,约登指数最大;外周血NLR联合PLR、NLR联合PCT、PLR联合PCT及三者联合诊断导管相关血流感染的AUC分别为0.876、0.902、0.856、0.916,其中三者联合诊断效能最高。结论TLR4基因rs11536889位点与感染发生相关,血液透析血管通路全身感染患者存在外周血NLR、PLR、PCT水平升高,在临床上可将其单独或联合用于血管通路全身感染患者的诊断。OBJECTIVE To explore the diagnostic value of TLR4 genotype distribution and peripheral blood neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR)and procalcitonin(PCT)in vascular access infections in hemodialysis patients.METHODS During the period from Feb.2014 to Oct.2019,110 hemodialysis patients from the First People’s Hospital of Xiaoshan District with vascular access infection were recruited in the infected group,and 89 hemodialysis patients without vascular access infection were enrolled in the uninfected group.Bacterial culture and drug resistance analysis were performed in patients of the infected group,and TLR4 gene polymorphisms were detected in both groups.NLR,PLR and PCT levels were detected in patients on the day of suspected infection.RESULTS There were 128 strains of pathogens isolated out from the 110 patients of the infection group,including 78 strains of Gram-negative bacteria(60.94%),47 strains of Gram-positive bacteria(36.72%),and 3 strains of fungi(2.34%).The drug resistance rates of Gram-negative bacteria were relatively higher to piperacillin,ampicillin,cefotaxime,cefaclor and ampicillin-sulbactam,and relatively lower to meropenem and imipenem.The drug resistance rates of Gram-positive bacteria were relatively higher to erythromycin,clindamycin,ciprofloxacin,gentamicin and levofloxacin,and lower to linezolid and vancomycin.Hardy-Weinberg equilibrium test showed that TLR4 gene at rs11536889 locus was in accordance with the Hardy-Weinberg equilibrium among different groups,and TLR4 gene at rs11536889 locus was related to the occurrence of infection(P<0.05).NLR,PLR and PCT levels in peripheral blood in the systemic bloodstream infection group were significantly higher than those in the local infection group and non-infection group(P<0.05).The areas under the curve(AUC)values of NLR,PLR and PCT in peripheral blood for diagnosis of vascular access blood flow infection were 0.813,0.797 and 0.855,respectively.The AUC of PCT for diagnosis was the largest;the Youden index was the larges

关 键 词：中性粒细胞/淋巴细胞比值 血小板/淋巴细胞比值 降钙素原 血液透析 血管通路感染 

分 类 号：R473[医药卫生—护理学]