皮肌炎合并感染影响因素及外周血单核细胞Toll样受体表达  

Influencing factors for infection and expressions of Toll-like receptors in peripheral blood mononuclear cells of dermatomyositis patients

作　　者：朱莉[1] 黎智[2] 郑玲玲[1] 张寅 ZHU Li;LI Zhi;ZHENG Ling-ling;ZHANG Yin(Xinqiao Hospital of Army Medical University(Third Military Medical University),Chongqing 400037,China;不详)

机构地区：[1]陆军军医大学(第三军医大学)新桥医院预防保健科,重庆400037 [2]重庆市中医院皮肤科,重庆400000

出　　处：《中华医院感染学杂志》2023年第9期1375-1379,共5页Chinese Journal of Nosocomiology

摘　　要：目的探讨皮肌炎(DM)合并感染影响因素,分析患者外周血单核细胞Toll样受体(TLR)表达变化。方法选取2016年5月-2021年5月陆军军医大学新桥医院确诊的85例DM患者,根据是否合并感染分为感染组29例和未感染组56例。无菌收集患者痰液、尿液、粪便和皮肤鳞屑标本,进行病原菌培养及鉴定,统计感染部位分布特征。采用Logistic回归分析DM患者合并感染的影响因素。采用荧光定量PCR检测两组患者外周血单核细胞TLR2和TLR4 mRNA表达;采用流式细胞仪检测外周血单核细胞TLR2/4蛋白相对荧光强度(rMFI)。结果DM患者合并感染发生率为34.11%,感染部位主要为呼吸道(37.93%)和皮肤黏膜(31.03%),分离菌株以革兰阴性菌(47.06%)为主。Logistic回归分析结果显示,侵入性操作和低蛋白血症为DM患者合并感染的独立影响因素,联用免疫球蛋白是DM患者合并感染的保护因素(P<0.05);感染组TLR2 mRNA、TLR4 mRNA表达水平及TLR2 rMFI、TLR4 rMFI蛋白表达水平均高于未感染组(P<0.05)。结论DM合并感染患者外周血单核细胞TLR2和TLR4表达异常,侵入性操作和低蛋白血症为感染发生的独立影响因素,而联用免疫球蛋白为保护因素。OBJECTIVE To explore the influencing factors for infection in the patients with dermatomyositis(DM) and observe the changes of expressions of Toll-like receptors(TLR) in peripheral blood mononuclear cells(PBMCs). METHODS A total of 85 patients who were diagnosed with DM and treated in Xinqiao Hospital of Army Medical University from May 2016 to May 2021 were enrolled in the study and divided into the infection group with 29 cases and the no infection group with 56 cases according to the status of complication with infection. The sputum, urine, stool and skin scale specimens were collected from the patients by sterile approaches, pathogens were cultured and identified. The characteristics of infection sties were statistically analyzed. Logistic regression analysis was performed for the influencing factors for the infection in the DM patients, the expressions of TLR2 and TLR4 mRNA in PBMCs were detected by fluorescent quantitative PCR, and the relative mean fluorescent intensity(rMFI) of TLR2/4 in PBMCs was detected by flow cytometry. RESULTS The incidence of infection was 34.11% among the DM patients, the patients with respiratory tract infection accounted for 37.93%, and the patients with skin mucosa infection accounted for 31.03%. The gram-negative bacteria accounted for 47.06% among the isolated pathogens. Logistic regression analysis showed that invasive operation and hypoproteinemia were independent influencing factors for the infection in the DM patients, the combination with immunoglobulins was the protective factor for the infection in the DM patients(P<0.05). The expression levels of TLR2 mRNA, TLR4 mRNA, TLR2 rMFI and TLR4 rMFI proteins of the infection group were higher than those of the no infection group(P<0.05). CONCLUSION The DM patients complicated with infection show abnormal expressions of TLR2 and TLR4 in PBMCs. The invasive operation and hypoproteinemia are the independent influencing factors for the infection, while the combination with immunoglobulins is the protective factor.

关 键 词：皮肌炎 感染 影响因素 单核细胞Toll样受体2 单核细胞Toll样受体4 

分 类 号：R593.26[医药卫生—内科学]