系统性红斑狼疮患者JAK/STAT信号通路表达与继发深部真菌感染的关联  

Relationship between expressions of JAK/STAT signaling pathways and secondary deep fungal infection in patients with systemic lupus erythematosus

作　　者：钟会英 谢立虎 欧大明 黄丽芳 李洁 ZHONG Hui-ying;XIE Li-hu;OU Da-ming;HUANG Li-fang;LI Jie(The First Affiliated Hospital,Hengyang Medical College,University of South China,Hengyang,Hunan 421001,China)

机构地区：[1]南华大学衡阳医学院附属第一医院风湿免疫科,湖南衡阳421001

出　　处：《中华医院感染学杂志》2022年第15期2294-2298,共5页Chinese Journal of Nosocomiology

基　　金：湖南省卫生健康委2020年科研立项课题(20200050)。

摘　　要：目的探讨系统性红斑狼疮(SLE)患者Janus激酶/信号转导转录活化因子(JAK/STAT)信号通路表达与继发深部真菌感染的关系。方法选取2017年10月-2020年10月南华大学衡阳医学院附属第一医院收治的SLE继发深部真菌感染患者42例(真菌感染组)和非感染患者266例(非感染组),分析病原菌分布情况,实时定量聚合酶链式反应检测外周血单个核细胞JAK/STAT信号通路相关因子水平并分析其与继发深部真菌感染的关系。结果占比前三的真菌分别为白假丝酵母、光滑假丝酵母、热带假丝酵母;两组患者住院时间、使用抗生素时间、24 h尿蛋白定量、补体C3、器官损伤及受累数、SLE活动指数(SLEDAI)评分比较有统计学差异,真菌感染组患者白细胞介素-6(IL-6)、白细胞介素-12(IL-12)、白细胞介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、降钙素原(PCT)水平、STAT1、STAT3、STAT4、STAT6、TYK2 mRNA水平高于非感染组患者(P<0.05),干扰素-γ(IFN-γ)水平低于非感染组(P<0.05)。使用抗菌药物时间≥2周、器官损伤及受累数≥3个、SLEDAI评分≥10分和补体C3<0.8 mg/L是SLE患者并发继发深部真菌感染的影响因素(P<0.05)。结论SLE并继发深部真菌感染患者JAK/STAT信号通路活化程度较高,体内免疫炎症反应增强,疾病所致损伤更严重。OBJECTIVE To explore the relationship between expressions of Janus kinase/signal transducer and activators of transcription(JAK/STAT)signaling pathways and secondary deep fungal infection in patients with systemic lupus erythematosus(SLE).METHODS A total of 42 SLE patients admitted to the First Hospital Affiliated to Hengyang Medical College of Nanhua University were enrolled between Oct 2017 and Oct 2020.Patients with deep fungal infection were divided into the infection group and 266 SLE patients without infection were in the non-infection group.The distribution of pathogens was analyzed.The levels of JAK/STAT signaling pathways related factors in peripheral blood mononuclear cells were detected by real-time quantitative polymerase chain reaction,and their relationship with secondary deep fungal infection was analyzed.RESULTS The top three fungi were candida albicans,candida glissima and candida tropicalis.There were significant differences in hospitalization time,antibiotic use time,24 h urinary protein quantification,complement C3,organ damage and involvement,and SLEDAI score between the two groups.The levels of interleukin-6(IL-6),interleukin-12(IL-12),interleukin-4(IL-4),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),procalcitonin(PCT),STAT1,STAT3,STAT4,STAT6 and TYK2 mRNA in the fungal infection group were significantly higher than those in the non-infection group(P<0.05),while the level of interferon-γ(IFN-γ)was significantly lower than that in the non-infection group(P<0.05).Antibiotics usage time≥2 weeks,number of damaged and involved organs≥3,SLEDAI score≥10 points and complement C3<0.8 mg/L were risk factors for secondary deep fungal infection in SLE patients(P<0.05).CONCLUSION In SLE patients with secondary deep fungal infection,the activation of JAK/STAT signaling pathway is higher,the immune inflammatory response in vivo is enhanced,and the damage caused by the disease is more serious.

关 键 词：系统性红斑狼疮 深部真菌感染 病原学 JAK/STAT信号通路 危险因素 

分 类 号：R593.241[医药卫生—内科学]