糖尿病足感染患者病原学及其与Toll样受体信号通路的关系  

Association of etiological characteristics with toll-like receptor signaling pathways in patients with diabetic foot infection

作　　者：杨雨平[1] 林东源[1] 叶健波[1] 蒙志平 潘凤珍 刘丽梦 龙一军[1] YANG Yu-ping;LIN Dong-yuan;YE Jian-bo;MENG Zhi-ping;PAN Feng-zhen;LIU Li-meng;LONG Yi-jun(Guigang People′s Hospital,Guigang,Guangxi 537100,China)

机构地区：[1]广西贵港市人民医院内分泌科,广西贵港537100 [2]广西贵港市人民医院检验科,广西贵港537100

出　　处：《中华医院感染学杂志》2023年第12期1823-1827,共5页Chinese Journal of Nosocomiology

基　　金：广西壮族自治区科研基金资助项目(2021KJ0112)。

摘　　要：目的 分析糖尿病足感染患者病原菌分布、Toll样受体(TLR)信号通路表达变化及其与感染的关系。方法 选择2019年1月-2021年12月广西贵港市人民医院收治的糖尿病足感染患者308例(糖尿病足Wagner分级2级58例、3级103例、4级114例、5级33例)纳入研究组,单独糖尿病足患者314例纳入对照组;分析两组临床资料,糖尿病足感染患者病原菌特征,研究组、对照组及不同感染程度患者TLR信号通路指标,通过Pesrson相关性分析法分析TLR信号通路与血清指标的相关性,通过Spearman相关性分析TLR信号通路与感染程度的相关性。结果 研究组患者血清甘油三酯(TG)、胰岛素(FINS)水平高于对照组,25羟维生素D[25(OH)D]水平低于对照组(P<0.05);308例糖尿病足感染患者共分离病原菌375株,其中革兰阴性菌232株占61.87%,革兰阳性菌137株占36.53%,真菌6株占1.60%;研究组外周血TLR-2、TLR-4、TLR-9水平高于对照组(P<0.05);2级、3级、4级、5级糖尿病足感染患者外周血TLR-2、TLR-4、TLR-9水平呈升高趋势(P<0.05);TG、FINS与TLR-2、TLR-4、TLR-9呈正相关(P<0.05);25(OH)D与TLR-2、TLR-4、TLR-9呈负相关(P<0.05);TLR-2、TLR-4、TLR-9与感染程度呈正相关(P<0.05)。结论 糖尿病足感染患者病原菌以革兰阴性菌为主,TLR-2、TLR-4、TLR-9表达增加,且TLR-2、TLR-4、TLR-9水平与病情进展及疾病相关血清指标密切相关,可作为临床诊治的新靶点。OBJECTIVE To analyze the distribution of pathogenic bacteria and changes of toll-like receptor(TLR) signaling pathway expression in patients with diabetic foot infection and their relationship with infection.METHODS A total of 308 patients with diabetic foot infection admitted to the Guangxi Guigang People′s Hospital from Jan.2019 to Dec.2021(Wagner scale for diabetic feet:58 patients with grade 2 103 patients with grade 3 114 patients with grade 4 and 33 patients with grade 5) were included in the study group,and 314 patients with diabetic foot alone were included in the control group.The clinical data of the two groups,the characteristics of pathogenic bacteria in patients with diabetic foot infection,TLR signaling pathway indexes in the study group,the control group and patients with different infection severity were analyzed.The correlation between TLR signaling pathway and serum indicators was analyzed by Pesrson correlation analysis,Spearman correlation analysis was used to analyze the correlation between TLR signaling pathway and infection severity.RESULTS Serum levels of triglyceride(TG) and insulin(FINS) in the study group were higher than those in the control group,while serum levels of 25 hydroxyvitamin D[25(OH)D] in the study group were lower than that in the control group(P<0.05).A total of 375 strains of pathogenic bacteria were isolated from 308 patients with diabetic foot infection,of which 232 strains of Gram-negative bacteria accounted for 61.87%,137 strains of Gram-positive bacteria accounted for 36.53% and 6 strains of fungi accounted for 1.60%.The levels of TLR-2,TLR-4 and TLR-9 in the peripheral blood of the study group were higher than those of the control group(P<0.05).The levels of TLR-2,TLR-4 and TLR-9 in peripheral blood of grade 2,3,4 and 5 diabetic foot infection patients showed an increased tend(P<0.05).TG and FINS were positively correlated with TLR-2,TLR-4 and TLR-9(P<0.05),while 25(OH)D was negatively correlated with TLR-2,TLR-4 and TLR-9(P<0.05).TLR-2,TLR-4 and TLR-9 were posit

关 键 词：糖尿病足 感染 病原菌 Toll样受体-2 TOLL样受体-4 TOLL样受体-9 相关性 

分 类 号：R587.1[医药卫生—内分泌]