老年下肢动脉硬化闭塞症介入术后感染PD-1和sCD14与Smac水平  

Levels of PD-1,sCD14 and Smac in elderly patients with lower extremity arteriosclerosis obliterans complicated with infection after interventional therapy

作　　者：张名林 史键山 邓堂[1] 孙刚 金桂云[1] ZHANG Ming-lin;SHI Jian-shan;DENG Tang;SUN Gang;JIN Gui-yun(The First Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570102,China)

机构地区：[1]海南医学院第一附属医院介入血管外科,海南海口570102

出　　处：《中华医院感染学杂志》2023年第19期2963-2967,共5页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(SQ2020MSXM0901)。

摘　　要：目的探究老年下肢动脉硬化闭塞症(ASO)介入术后感染患者外周血程序性死亡受体1(PD-1)、可溶性CD14(sCD14)、第二线粒体源性半胱天冬酶激活剂(Smac)水平.方法选取2017年9月-2020年9月于海南医学院第一附属医院介入血管外科进行介入手术的老年ASO术后感染患者64例设为研究组,另选同期收治的ASO术后未并发感染老年患者60例设为对照组;按照抗感染治疗效果,将感染患者分为有效组(n=46)和无效组(n=18),分析导致术后感染的病原菌及危险因素,检测各组患者外周血PD-1、sCD14和Smac水平,采用受试者工作特征(ROC)曲线分析外周血PD-1、sCD14和Smac水平对抗感染疗效的评估价值.结果感染患者创口分泌物中共培养分离病原菌98株,其中革兰阳性菌75株占76.53%,以金黄色葡萄球菌为主,革兰阴性菌23株占23.47%,以大肠埃希菌为主;糖尿病史、留置导尿管、预防性使用抗菌药物、住院时间是老年ASO介入术后感染的危险因素(P<0.05);与对照组相比,研究组患者外周血PD-1和sCD14水平升高,Smac水平降低(P<0.05);与无效组相比,有效组患者外周血PD-1和sCD14水平下降,Smac水平升高(P<0.05);ROC曲线结果显示,当PD-1≤2.82%、sCD14≤62.58 ng/ml、Smac>0.41μg/ml时预测抗感染疗效的效能最佳(P<0.05).结论革兰阳性菌是老年ASO介入术后感染的主要致病菌,老年ASO介入术后感染与糖尿病史、留置导尿管、预防性使用抗菌药物、住院时间有关.老年ASO患者外周血中PD-1、sCD14水平升高,Smac水平降低,经抗感染治疗后,PD-1、sCD14水平下降,Smac水平升高,监测外周血PD-1、sCD14和Smac水平可有效评估临床抗感染治疗效果.OBJECTIVE To investigate the levels of peripheral blood programmed death receptor 1(PD-1),soluble CD14 subtype(sCD14)and second mitochondria-derived activator of caspases(Smac)in elderly patients with lower extremity arteriosclerosis obliterans(ASO)infection after interventional therapy.METHODS Totally 64 elderly patients with infection after ASO surgery who underwent interventional surgery in department of interventional vascular surgery of the First Affiliated Hospital of Hainan Medical University between Sep.2017 and Sep.2020 were selected as the study group,and another 60 elderly patients without infection after ASO surgery during the same period were selected as the control group. According to the effect of anti-infective treatment, the infected patientswere divided into effective group (n=46) and ineffective group (n =18). The pathogenic bacteria and riskfactors that caused the postoperative infection were analyzed and the levels of peripheral blood PD-1, sCD14 andSmac were detected in each group. Receiver operating characteristic curve (ROC) was used to analyze the evaluatedvalue of peripheral blood PD-1, sCD14 and Smac on anti-infection efficacy. RESULTS A total of 98 strains ofpathogenic bacteria were cultured and isolated from the wound secretions of infected patients. of which 75 strainsof Gram-positive bacteria accounted for 76.53%, mainly Staphylococcus aureus, and 23 strains of gram-negativebacteria accounted for 23.47%, mainly Escherichia coli. The history of diabetes, indwelling catheter, prophylacticuse of antibiotics, and hospital stay were risk factors for post-interventional infection in elderly ASO patients (P<0.05). Compared with the control group, the levels of peripheral blood PD-1 and sCD14 of patients in the studygroup were increased, while the Smac level was decreased (P<0.05). The levels of peripheral blood PD-1 andsCD14 in effective group were reduced, while the Smac level was risen compared to ineffective group (P<0.05).The ROC curve results showed that when PD-1<2.82%, sCD14<62.58 n

关 键 词：下肢动脉硬化闭塞症 介入术 术后感染 病原菌 外周血程序性死亡受体1 可溶性CD14 第二线粒体源性半胱天冬酶激活剂 抗感染疗效 老年 

分 类 号：R619.3[医药卫生—外科学]