耐碳青霉烯肠杆菌科细菌血流感染患者外周血淋巴细胞自噬特征及其意义  

Changes and significance of autophagy in peripheral blood lymphocytes of patients with carbapenemresistant Enterobacteriaceae-bloodstream infection

作　　者：黄琳玲 许美蓉 沈晓雯[1] 顾玲莉 沈红梅 HUANG Linling;XU Meirong;SHEN Xiaowen;GU LingLi;SHEN Hongmei(Department of Clinical Laboratory,the Second People's Hospital of Nantong,Nantong 226000,Jiangsu,China)

机构地区：[1]南通市第二人民医院检验科,江苏南通226000

出　　处：《检验医学》2024年第8期759-763,共5页Laboratory Medicine

基　　金：南通市科技计划项目(MSZ20003);南通市卫生健康委员会科研课题(QNZ2023060)。

摘　　要：目的分析耐碳青霉烯肠杆菌科细菌(CRE)血流感染(BSI)患者外周血淋巴细胞自噬特征及其临床意义。方法选取2019年6月—2022年6月南通市第二人民医院125例CRE-BSI患者(耐药组)和130例碳青霉烯类敏感细菌BSI患者(敏感组),以同期105名健康志愿者作为对照组。比较3个组外周血淋巴细胞自噬标志基因Beclin-1、LC3、Atg5a的mRNA水平差异。收集耐药组相关临床资料,比较死亡患者、存活患者临床特征和Beclin-1、Atg5a、LC3的mRNA水平的差异。采用Logistic回归分析评价耐药组患者死亡的影响因素。结果耐药组外周血淋巴细胞Beclin-1、LC3、Atg5a的mRNA水平低于敏感组和对照组(P<0.05)。耐药组外周血淋巴细胞Beclin-1、LC3、Atg5a的mRNA水平与急性生理和慢性健康评分Ⅱ(APACHEⅡ)评分、白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)水平均呈负相关(P<0.05)。耐药组死亡患者和存活患者之间外周血淋巴细胞Beclin-1、LC3、Atg5a的mRNA水平和年龄、呼吸道来源感染、合并感染性休克发生率,以及hs-CRP、PCT、APACHEⅡ评分差异均有统计学意义(P<0.05)。外周血淋巴细胞Beclin-1、LC3的mRNA水平和呼吸道来源感染、合并感染性休克、APACHEⅡ评分是耐药组患者死亡的危险因素(P<0.05)。结论CRE-BSI患者外周血淋巴细胞自噬减弱与病情加重、预后不良有关。Objective To analyze the characteristics and clinical significance of autophagy in peripheral blood lymphocytes of patients with carbapenem-resistant Enterobacteriaceae(CRE)-bloodstream infection(BSI).Methods Totally,125 patients with CRE-BSI(drug-resistant group)and 130 patients with carbapenem-sensitive bacterium-BSI(drug-sensitive group)were enrolled from the Second People's Hospital of Nantong from June 2019 to June 2022,and 105 healthy subjects were enrolled as control group.The mRNA expression levels of autophagy marker genes(Beclin-1,LC3 and Atg5a)in peripheral blood lymphocytes were determined,and the differences were compared.The clinical data of drug-resistant group were collected.The differences of clinical characteristic and Beclin-1,Atg5a,LC3 mRNA levels between death and survival patients were compared.Logistic regression analysis was used to evaluate the prognostic factors in drug-resistant group.Results The Beclin-1,LC3 and Atg5a mRNA levels of peripheral blood lymphocytes in drug-resistant group were lower than those in drug-sensitive group and control group(P<0.05).Beclin-1,LC3 and Atg5a mRNA levels in peripheral blood lymphocytes in drugresistant group were negatively correlated with acute physiological and chronic health evaluationⅡ(APACHEⅡ)score,white blood cell(WBC)count,high-sensitivity C-reactive protein(hs-CRP)and procalcitonin(PCT)levels(P<0.05).There was statistical significance in Beclin-1,LC3 and Atg5a mRNA levels and age,respiratory tract infection,septic shock,hs-CRP,PCT and APACHEⅡscores between death and survival patients in drugresistant group(P<0.05).Beclin-1 and LC3 mRNA levels in peripheral blood lymphocytes,respiratory tract infection,septic shock and APACHEⅡscore were the influential factors for death in drug-resistant group(P<0.05).Conclusions The weakened autophagy of peripheral blood lymphocytes in CRE-BSI patients is related to disease aggravation and poor prognosis.

关 键 词：耐碳青霉烯肠杆菌科细菌 血流感染 淋巴细胞 自噬 预后 

分 类 号：R378.99[医药卫生—病原生物学]