维持血液透析患者中心静脉导管相关血流感染影响因素及肿瘤坏死因子-α基因多态性  

Influencing factors for central venous catheter-related bloodstream infection in maintenance hemodialysis patients and gene polymorphism of tumor necrosis factor-α

作　　者：崔丽红 孙长喜[1] 师军华 CUI Li-hong;SUN Chang-xi;SHI Jun-hua(Tianjin Fifth Central Hospital,Tianjin 300451,China)

机构地区：[1]天津市第五中心医院肾内科,天津300451

出　　处：《中华医院感染学杂志》2023年第9期1333-1337,共5页Chinese Journal of Nosocomiology

基　　金：天津市卫生计生行业科研项目(19A20142)。

摘　　要：目的探究维持血液透析(MHD)患者发生中心静脉导管相关血流感染(CRBSI)影响因素及肿瘤坏死因子-α(TNF-α)基因多态性。方法选择2016年10月-2021年10月天津市第五中心医院收治的32例发生CRBSI的MHD患者为研究组,68例未发生CRBSI患者为对照组,采集外周血检测TNF-α-308 G/A位点基因分布及降钙素原(PCT)和C-反应蛋白(CRP)水平;多因素Logistic回归分析MHD患者发生CRBSI的影响因素。结果研究组患者TNF-α-308 G/A位点AA基因及A等位基因频率高于对照组(P<0.05);研究组AA型患者血清TNF-α、PCT、CRP水平高于GA型和GG型(P<0.05);多元Logisitic回归分析显示,置管时间>7 d、预防性应用抗菌药物、严格进行手卫生以及TNF-α-308 G/A位点AA基因是MHD患者发生CRBSI的独立影响因素(P<0.05);依据影响因素构建的CRBSI预测模型,经Hosmer-Lemeshow拟合优度检验(P=0.813),模型有着良好的拟合优度;受试者工作特征(ROC)曲线分析显示,模型的曲线下面积(AUC)为0.829(95%CI:0.714~0.897),灵敏度与特异度分别为79.50%、87.30%。结论置管时间>7d、预防性应用抗菌药物、严格进行手卫生以及TNF-α-308 G/A位点AA基因型是患者CRBSI发生影响因素,由此构建感染预测模型对于CRBSI预测效能优异。OBJECTIVE To explore the influencing factors for central venous catheter-related bloodstream infection(CRBSI)in the maintenance hemodialysis(MHD)patients and analyze the gene polymorphism of tumor necrosis factor-α(TNF-α).METHODS From Oct 2016 to Oct 2021,a total of 32 MHD patients who were treated in Tianjin Fifth Central Hospital and had CRBSI were assigned as the study group,and 68 patients who did not have CRBSI were chosen as the control group.The peripheral blood specimens were collected to detect the genotypes at TNF-α-308 G/A locus and the levels of procalcitonin(PCT)and C-reactive protein(CRP).Multivariate logistic regression analysis was performed for the influencing factors for the CRBSI in the MHD patients.RESULTS The frequencies of AA genotype and A allele at TNF-α-308 G/A of the study group were higher than those of the control group(P<0.05).In the study group,the levels of serum TNF-α,PCT and CRP of the patients with AA genotype were higher than those of the patients with GA genotype and GG genotype(P<0.05).Multivariate logistic regression analysis showed that the catheter indwelling time more than 7 days,prophylactic use of antibiotics,strict implementation of hand hygiene and AA genotype at TNF-α-308 G/A locus were the independent influencing factors for the CRBSI in the MHD patients(P<0.05).The prediction model for CRBSI was established based on the influencing factors and was tested by Hosmer-Lemeshow goodness-of-fit(P=0.813),the model had favorable goodness-of-fit.Receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)was 0.829(95%CI:0.714-0.897),with the sensitivity 79.50%,the specificity 87.30%.CONCLUSION The catheter indwelling time more than 7 days,prophylactic use of antibiotics,strict implementation of hand hygiene and TNF-α-308 G/A locus AA genotype are the influencing factors for the CRBSI,and the prediction model established based on the influencing factors shows excellent efficiency in prediction of CRBSI.

关 键 词：肿瘤坏死因子-Α 基因多态性 维持血液透析 中心静脉导管相关血流感染 影响因素 炎性因子 

分 类 号：R459.5[医药卫生—治疗学]