胫骨开放性骨折术后感染的危险因素及NLRP3信号通路变化  

Risk factors for postoperative infection in patients with open fracture of tibia and changes of NLRP3 signaling pathways

作　　者：吴彬 张雄军 李国湘 WU Bin;ZHANG Xiong-jun;LI Guo-xiang(Ding'an People's Hospital,Ding'an,Hainan 571200,China)

机构地区：[1]定安县人民医院外二科,海南定安571200

出　　处：《中华医院感染学杂志》2023年第18期2810-2814,共5页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金项目(20193897)。

摘　　要：目的筛选胫骨开放性骨折术后感染的危险因素并构建预测模型,分析核苷酸结合寡聚化结构域样受体3(NLRP3)信号通路变化.方法选取2019年6月-2022年12月定安县人民医院收治的胫骨开放性骨折患者189例纳入研究,根据术后感染情况分为感染组34例和非感染组155例.归纳胫骨开放性骨折患者术后感染的危险因素并构建模型,绘制受试者工作特征(ROC)曲线分析其预测价值,并分析NLRP3信号通路变化.结果189例胫骨开放性骨折患者并发术后感染34例,感染率为17.99%;多因素Logistic分析结果显示,合并糖尿病、低蛋白血症、合并骨筋膜室综合征为胫骨开放性骨折患者术后感染的危险因素(P<0.05);将上述因素纳入危险因素模型:Logit(P)=-5.464+0.631×合并糖尿病+0.748×低蛋白血症+0.532×合并骨筋膜室综合征,绘制模型预测术后感染的ROC曲线,曲线下面积(AUC)为0.908,诊断灵敏度88.42%、特异度为84.69%;感染组NLRP3、效应蛋白半胱天冬酶-1(Caspase-1)、白细胞介素(IL)-1βmRNA相对表达量水平高于非感染组(P<0.05).结论NLRP3信号通路可能参与胫骨开放性骨折患者术后感染过程,感染相关危险因素较多,构建的模型具有良好的预测价值.OBJECTIVE To screen out the risk factors for postoperative infection in the patients with open fracture of tibia,establish the prediction model and observe the changes of nucleotide-binding oligomeric domain-like receptor 3(NLRP3)signaling pathways.METHODS A total of 189 patients with open fracture of tibia who were treated in Ding'an People's Hospital from Jun 2019 to Dec 2022 were enrolled in the study and were divided into the infection group with 34 cases and the non-infection group with 155 cases according to the status of postoperative infection.The risk factors for the postoperative infection were concluded,the prediction model was established,the predictive value of the model was analyzed by means of receiver operating characteristic(ROC)curves,and the changes of NLRP3 signaling pathways were observed.RESULTS Among the 189 patients with open fracture of tibia,34 were complicated with postoperative infection,with the infection rate 17.99%.The result of multivariate logistic analysis showed that complication with diabetes mellitus,hypoproteinemia and complication with osteofascial compartment syndrome were the risk factors for postoperative infection in the patients with open fracture of tibia(P<0.05).The above factors were brought into the prediction model:Logit(P)=-5.464+0.631×com-plication with diabetes mellitus+0.748×hypoproteinemia+0.532×complication with osteofascial compartment syndrome.The ROC curves of the model in prediction of postoperative infection were drawn,the area under curve(AUC)was 0.908,with the sensitivity 88.42%,the specificity 84.69%.The relative expression levels of NLRP3,effect protein caspase-1(Caspase-1)and interleukin-1p(IL-1p)of the infection group were higher than those of the non-infection group(P<0.05).CONCLUSION NLRP3 signaling pathways may participate in the process of postoperative infection in the patients with open fracture of tibia.There are a variety of risk factors for the infection.The model has high predictive value.

关 键 词：胫骨开放性骨折 术后感染 核苷酸结合寡聚化结构域样受体3 危险因素 模型 预测价值 

分 类 号：R619.3[医药卫生—外科学]