下肢开放性骨折术后切口感染外周血miR-223、Smad通路蛋白表达及其诊断价值  

Expressions of miR-223 and Smad pathway proteins in peripheral blood of open lower limb fracture patients with postoperative incision infection and diagnostic values

作　　者：肖捷[1] 傅小军[1] 廖鑫 黄家琦 张必 XIAO Jie;FU Xiao-jun;LIAO Xin;HUANG Jia-qi;ZHANG Bi(Jiande First People's Hospital,Jiande,Zhejiang 311600,China)

机构地区：[1]建德市第一人民医院骨科,浙江建德311600

出　　处：《中华医院感染学杂志》2023年第17期2669-2673,共5页Chinese Journal of Nosocomiology

基　　金：杭州市科技局科技发展基金(2017NG03)。

摘　　要：目的探讨下肢开放性骨折术后感染患者外周血微小核糖核酸-223(miR-223)、果蝇同源信号蛋白(Smad)表达及其诊断价值.方法选取2018年12月-2021年12月建德市第一人民医院骨科收治的因下肢开放性骨折行内固定术患者350例为研究对象,根据术后感染情况分为感染组32例和未感染组318例.无菌采集伤口周围分泌物,进行病原菌分离鉴定.术后2 d采集空腹静脉血,检测炎症因子C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、降钙素原(PCT)水平和miR-223、Smad通路蛋白及其上下游因子转化生长因子-β(TGF-β)、血管内皮生长因子(VEGF)表达.结果下肢开放性骨折患者术后感染率为9.14%,分离病原菌以革兰阳性菌(63.16%)为主;两组年龄、合并糖尿病、术中出血量、术后引流量和卧床时间比较有统计学差异(P<0.05);感染组术后IL-6、TNF-α、CRP和PCT水平均高于未感染组(P<0.05),miR-223、Smad1、Smad2、Smad3和TGF-β、VEGF水平均高于未感染组(P<0.05),且预测下肢开放性骨折术后感染的曲线下面积(AUC)均>0.7,预测效能较高.结论下肢开放性骨折患者术后感染可引起外周血miR-223、Smad通路蛋白异常表达,并且对术后感染具有较好的预测价值.OBJECTIVE To explore the expressions of microRNA-223(miR-223)and consanguinity signal protein of drosophila melanogaster(Smad)in peripheral blood of open lower limb fracture patients with postoperative infection and analyze the diagnostic values.METHODS A total of 350 patients who underwent internal fixation in orthopedics department of Jiande First People's Hospital due to open lower limb fracture from Dec 2018 to Dec 2021 were recruited as the research subjects and were divided into the infection group with 32 cases and the no infection group with 318 cases according to the status of postoperative infection.The wound secretions specimens were collected by aseptic means,pathogens were isolated and identified.The fasting venous blood specimens were collected after the surgery for 2 days,the levels of inflammatory factors C-reactive protein,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),procalcitonin(PCT)and the expression levels of miR-223,Smad pathway proteins as well as upstream and downstream factors transforming growth factor-β(TGF-β),vascular endothelial growth fac-tor(VEGF)were detected.RESULTS The incidence rate of postoperative infection was 9.14%among the patients with open lower limb fracture patients.Gram-positive bacteria were dominant among the isolated pathogens,accounting for 63.16%.There were significant differences in age,complication with diabetes mellitus,intraoperative blood loss volume,postoperative drainage volume and bedridden time between the two groups(P<0.05).The levels of postoperative IL-6,TNF-α,CRP and PCT of the infection group were higher than those of the no infection group(P<0.05);the levels of miR-223,Smadl,Smad2,Smad3,TGF-βand VEGF of the infection group were higher than those of the no infection group(P<0.05).The areas under curves(AUCs)were more than 0.7 in prediction of postoperative infection in the patients with open lower limb fracture patients,and the predictive efficiencies were high.CONCLUSION The postoperative infection may lead to the abnormal expressions of

关 键 词：下肢开放性骨折 术后感染 切口感染 微小核糖核酸-223 果蝇同源信号蛋白 预测价值 

分 类 号：R683.42[医药卫生—骨科学]