心脏瓣膜置换术后肺部感染的影响因素及其与TNF-α基因多态性的关联  

Influencing factors for postoperative pulmonary infection in heart valve replacement patients and their association with TNF-αgene polymorphisms

作　　者：杨书强[1] 康娜[2] 王俊生[1] 高源 李苗苗 YANG Shu-qiang;KANG Na;WANG Jun-sheng;GAO Yuan;LI Miao-miao(Anyang People's Hospital,Anyang,Henan 455000,China)

机构地区：[1]安阳市人民医院心脏外科,河南安阳455000 [2]安阳市人民医院健康体检中心,河南安阳455000

出　　处：《中华医院感染学杂志》2023年第11期1650-1654,共5页Chinese Journal of Nosocomiology

基　　金：河南省科研基金资助项目(2020k021)。

摘　　要：目的分析肿瘤坏死因子-α(TNF-α)基因多态性与心脏瓣膜置换(HVR)术后肺部感染的关系,肺部感染病原菌及其影响因素,并建立HVR术后肺部感染易感因素预测模型。方法选取2016年1月-2021年7月安阳市人民医院接受HVR的82例心脏瓣膜病(HVD)患者,根据术后肺部感染情况分为感染组(n=29)和未感染组(n=53),检测两组TNF-α基因rs1800629位点的基因分型;分析感染病原菌,并归纳术后感染的影响因素并构建预测模型,通过受试者工作特征(ROC)曲线分析该模型的预测效能。结果29例HVR术后肺部感染患者共采集19例痰液标本、10例血液标本,共检出43株病原菌,其中革兰阴性菌27株、革兰阳性菌11株、真菌5株;感染组TNF-α基因rs1800629位点GG基因型与G等位基因频率低于未感染组(P<0.05),感染组GA、AA基因型频率与A等位基因频率高于未感染组(P<0.05);体外循环时间、ICU住院时间、TNF-α基因rs1800629位点AA基因型是HVD患者HVR术后肺部感染的影响因素(P<0.05);HVR术后肺部感染预测模型:Log(P)=-27.482-0.073×体外循环时间+0.086×ICU住院时间+1.016×TNF-α基因rs1800629位点AA基因型;ROC曲线分析显示HVR术后肺部感染预测模型曲线下面积(AUC)为0.924,95%CI:0.844~0.971,以0.351为预测cut-off,其预测敏感度、特异度分别为89.66%、84.91%。结论革兰阴性菌是HVD患者HVR术后肺部感染的常见致病菌,而体外循环时间、ICU住院时间、TNF-α基因rs1800629位点AA基因型是HVR术后肺部感染的易感因素。OBJECTIVE To analyze the relationship between tumor necrosis factor-α(TNF-α)gene polymorphism and pulmonary infection after heart valve replacement(HVR),the pathogenic bacteria of pulmonary infections and their influencing factors,and to develop a predictive model of susceptibility factors for pulmonary infection after HVR.METHODS A total of 82 patients with heart valve disease(HVD)who underwent HVR in Anyang People's Hospital from Jan.2016 to Jul.2021 were selected and divided into the infection group(n=29)and the non-infection group(n=53)based on postoperative pulmonary infection,the genotypes of rs1800629 locus of the TNF-αgene were detected in both groups;the pathogenic bacteria of infection were analyzed,the influencing factors of postoperative infection were summarized,and a prediction model was established,and the predictive efficacy of this model was analyzed using receiver operating characteristic(ROC)curve.RESULTS A total of 19 sputum samples and 10 blood samples were collected from 29 patients with pulmonary infection after HVR.43 strains of pathogenic bacteria were detected,including 27 strains of Gram-negative bacteria,11 strains of Gram-positive bacteria and 5 strains of fungi.The GG genotype and G allele frequencies at rs1800629 of the TNF-αgene were lower in the infection group than those in the non-infection group(P<0.05),and the GA genotype,AA genotype frequencies and A allele frequencies in the infection group were higher than those in the non-infection group(P<0.05).Duration of extracorporeal circulation,length of ICU stay and AA genotype of TNF-αgene rs1800629 were influencing factors of post-HVR pulmonary infection in patients with HVD(P<0.05).The prediction model for pulmonary infection after HVR was as follow:Log(P)=-27.482-0.073×duration of extracorporeal circulation+0.086×length of ICU stay+1.016×AA genotype of TNF-αgene rs1800629.ROC curve analysis showed that the area under the curve(AUC)of the model for predicting pulmonary infection after HVR was 0.924,with 95%CI of 0.844-0.

关 键 词：心脏瓣膜病 心脏瓣膜置换术 肿瘤坏死因子-α基因多态性 肺部感染 术后感染 影响因素 预测模型 

分 类 号：R563.1[医药卫生—呼吸系统]