胆总管结石合并感染患者外周血单个核细胞中CD36/mTORC1通路表达及其诊断价值  

Expression of CD36/mTORC1 pathway in peripheral blood mononuclear cells of patients with choledocholithiasis combined with infection and its diagnostic value

作　　者：施颖琦[1] 沈美琴[1] 樊锦河[1] SHI Ying-qi;SHEN Mei-qin;FAN Jin-he(Nantong First People's Hospital,Nantong,Jiangsu 226007,China)

机构地区：[1]南通市第一人民医院消化内科,江苏南通226007

出　　处：《中华医院感染学杂志》2024年第19期2969-2973,共5页Chinese Journal of Nosocomiology

基　　金：江苏省自然科学基金青年基金资助项目(BK20220162)。

摘　　要：目的探讨胆总管结石合并感染病原菌及外周血单个核细胞(PBMCs)中分化抗原36(CD36)/雷帕霉素靶蛋白复合物1(mTORC1)通路表达及其诊断价值。方法选取2020年8月-2023年8月南通市第一人民医院收治的胆总管结石合并感染患者79例设为感染组,同期83例胆总管结石无感染患者设为非感染组;统计胆总管结石合并感染患者胆汁中病原菌及其药敏分析;分别采用流式细胞术和免疫蛋白印迹法检测CD36/mTORC1通路水平,比较两组PBMCs中CD36、雷帕霉素靶蛋白(mTOR)、磷酸化的核糖体S6蛋白激酶(p-p70S6K)水平;采用受试者工作特征(ROC)曲线分析CD36、mTOR、P-p70S6K对胆总管结石合并感染的诊断价值。结果胆总管结石合并感染患者共培养分离病原菌91株,其中革兰阴性菌62株占68.13%,革兰阳性菌27株占29.67%,真菌2株占2.20%,以大肠埃希菌、肺炎克雷伯菌、粪肠球菌为主;大肠埃希菌对哌拉西林(86.96%)、氨苄西林(82.61%)耐药率较高,肺炎克雷伯菌对头孢他啶(85.71%)、氨苄西林(76.19%)耐药率较高,两者对美罗培南(0)、亚胺培南(0)敏感;粪肠球菌对氨苄青霉素(85.00%)、克林霉素(80.00%)耐药率较高,对万古霉素(0)、替考拉宁(0)敏感;感染组外周血PBMCs中CD36、mTOR、P-p70S6K分别为(27.66±8.95)%、0.82±0.26、0.64±0.20高于非感染组(P<0.05);绘制ROC曲线获得CD36、mTOR、P-p70S6K联合诊断的曲线下面积(AUC)高于各项单独检测(P<0.05)。结论胆总管结石合并感染后CD36/mTORC1通路被激活,联合检测CD36、mTOR、P-p70S6K有助于诊断胆总管结石合并感染。OBJECTIVE To investigate the expression of differentiation antigen 36(CD36)/rapamycin target complex 1(mTORC1)pathway in peripheral blood mononuclear cells(PBMCs)of patients with choledocholithiasis combined with infection and its diagnostic value and analyze the pathogens.METHODS A total of 79 patients with choledocholithiasis combined with infection admitted to Nantong First People's Hospital from August 2020 to August 2023 were selected and assigned as the infected group,and 83 patients without choledocholithiasis during the same period were selected as the non-infected group.The pathogenic bacteria in bile of patients with choledocholi-thiasis combined with infection and their sensitivity were analyzed.CD36/mTORC1 pathway related indexes were detected by flow cytometry and western blot,respectively.The levels of CD36,target protein of rapamycin(mTOR)and phosphorylated ribosome S6 protein kinase(p-p70S6K)in PBMCs were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of CD36,mTOR and p-p70S6K for the diagnosis of choledochal stone coinfection.RESULTS A total of 91 strains of pathogenic bacteria were cultured and isolated from patients with common bile duct stones complicated by infection,of which,62 strains of gram-negative bacteria accounted for 68.13%,27 strains of gram-positive bacteria accounted for 29.67%,and 2 strains of fungi accounted for 2.20%,with Escherichia coli,Klebsiella pneumoniae,and Enterococcus faecalis predominating.Escherichia coli had a high resistance rate to piperacillin(86.96%)and ampicillin(82.61%),Klebsiella pneumoniae had a high resistance rate to ceftazidime(85.71%)and ampicillin(76.19%),while both of them were sensitive to meropenem(0)and imipenem(0).Enterococcus faecalis had a high resistance rate to ampicillin(85.00%)and clindamycin(80.00%),while it was sensitive to vancomycin(0)and teicoplanin(O).The levels of CD36,mTOR,and p-p70S6K in peripheral blood PBMCs of the infected group were(27.66±8.95)%,0.82±0.26,and

关 键 词：胆总管结石 感染 病原菌 耐药性 分化抗原36/雷帕霉素靶蛋白复合物1 诊断价值 受试者工作特征曲线 

分 类 号：R575.7[医药卫生—消化系统]