急性缺血性脑卒中外周血IL-17和HMGB1及TSLP表达水平与继发医院感染的关系  

Relationship between peripheral blood IL-17,HMGB1,TSLP and secondary nosocomial infection in acute ischemic stroke

作　　者：李剑侠[1] 林小祥[1] 余勇波 黄先锋 LI Jianxia;LIN Xiaoxiang;YU Yongbo;HUANG Xianfeng(Department of Neurosurgery,Jiangbei Branch(Nanjing Dachang Hospital),Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu 210048,China)

机构地区：[1]东南大学附属中大医院江北院区(南京市大厂医院)神经外科,江苏南京210048

出　　处：《热带医学杂志》2023年第4期498-502,共5页Journal of Tropical Medicine

基　　金：江苏省卫生健康委科研课题(Z2018023)。

摘　　要：目的探讨急性缺血性脑卒中(AIS)外周血白细胞介素-17(IL-17)、高迁移率族蛋白B1(HMGB1)、胸腺基质淋巴细胞生成素(TSLP)表达水平与继发医院感染的关系。方法选取2017年1月-2021年12月东南大学附属中大医院江北院区收治的103例AIS患者,根据是否发生继发医院感染分为感染组(n=24)和非感染组(n=79)。分析感染组患者病原菌分布情况,检测并比较两组外周血IL-17、HMGB1、TSLP表达水平,采用logistic回归分析AIS患者继发医院感染的危险因素,绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)分析外周血IL-17、HMGB1、TSLP表达水平对AIS患者继发医院感染的预测价值。结果24例AIS继发医院感染患者共分离出36株病原菌,其中革兰阳性菌、革兰阴性菌、真菌占比分别为33.33%、61.11%、5.56%。感染组外周血IL-17、HMGB1、TSLP表达水平分别为(62.14±18.36)pg/mL、(6.02±1.68)ng/mL、(2.85±0.61)pg/mL,均高于非感染组(28.34±5.57)pg/mL、(2.28±0.49)ng/mL、(1.76±0.43)pg/mL,差异均有统计学意义(t=14.450、17.633、9.804,P均<0.05)。Logistic回归分析显示,血清IL-17、HMGB1及TSLP水平升高、年龄≥60岁、肺部疾病史、糖尿病、入院时美国国立卫生院卒中量表(NIHSS)评分≥14分、侵入性操作、吞咽障碍、住院时间≥14 d均为影响AIS患者继发医院感染的独立危险因素(P均<0.05)。ROC曲线显示,外周血IL-17、HMGB1、TSLP联合预测AIS患者继发医院感染的AUC为0.907,高于三者单独预测(AUC分别为0.759、0.744、0.710)(Z=3.143、2.881、3.146,P均<0.05)。结论AIS继发医院感染患者病原菌以革兰阴性菌为主,感染会引起AIS患者外周血IL-17、HMGB1、TSLP水平升高,三者联合检测对AIS继发医院感染具有良好的预测价值。Objective The aim of this study was to explore the relationship between peripheral blood interleukin-17(IL-17),high mobility group box B1(HMGB1),thymic stromal lymphopoietin(TSLP)and secondary nosocomial infection in acute ischemic stroke(AIS).Methods A total of 103 patients with AIS admitted to the Jiangbei Branch of Zhongda Hospital Affiliated to Southeast University were enrolled between January 2017 and December 2021.According to the presence or absence of secondary nosocomial infection,they were divided into infection group(n=24)and non-infection group(n=79).The distribution of pathogens in infection group was analyzed.The expression levels of peripheral blood IL-17,HMGB1 and TSLP between the two groups were compared.The risk factors of nosocomial infection were analyzed by logistic regression analysis.The predictive value of IL-17,HMGB1 and TSLP for nosocomial infection was analyzed by receiver operating characteristic(ROC)curves and area under the curve(AUC).Results In the 24 patients with nosocomial infection,there were 36 strains of pathogens,including Gram-positive bacteria,Gram-negative bacteria and fungi(33.33%,61.11%,5.56%).The expression levels of peripheral blood IL-17,HMGB1 and TSLP in infection group were higher than those in non-infection group(t=14.450,17.633,9.804,all P<0.05).Logistic regression analysis showed that increased IL-17,HMGB1 and TSLP levels,age≥60 years,history of lung diseases,diabetes mellitus,NIHSS score at admission≥14points,invasive operation,dysphagia and hospitalization time≥14 d were all independent risk factors of secondary nosocomial infection(P<0.05).ROC curves analysis showed that AUC of IL-17 combined with HMGB1 and TSLP for predicting secondary nosocomial infection was 0.907,greater than that of single index(0.759,0.744,0.710)(Z=3.143,2.881,3.146,all P<0.05).Conclusions The main pathogen of nosocomial infection was Gram-negative bacteria in AIS patients.The infection could increase IL-17,HMGB1 and TSLP levels.Their combined detection had good predictive value f

关 键 词：急性缺血性脑卒中 继发医院感染 白细胞介素-17 高迁移率族蛋白B1 胸腺基质淋巴细胞生成素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]