开放性骨折患者清创前、后创面细菌计数、NF-κB/JNK/PI3K炎症信号通路相关因子对骨感染的诊断价值  

Diagnostic value of wound bacterial count and NF-κB/JNK/PI3K inflammatory signaling pathway-related factors on bone infection in patients with open fracture before and after debridement

作　　者：欧双权 陈立 OU Shuangquan;CHEN Li(Department of Orthopedics,Dazhou Central Hospital,Dazhou,Sichuan 635000,China)

机构地区：[1]四川省达州市中心医院骨科,四川达州635000

出　　处：《检验医学与临床》2024年第23期3504-3509,共6页Laboratory Medicine and Clinic

基　　金：四川医学科研课题项目(2019HR1011)。

摘　　要：目的探讨开放性骨折患者清创前、后创面细菌计数和核因子-κB(NF-κB)/c-Jun N-末端激酶(JNK)/磷酸酰肌醇3-激酶(PI3K)炎症信号通路相关因子对骨感染的诊断价值。方法选取2020年1月至2023年8月达州市中心医院收治的开放性骨折患者257例,根据是否发生骨感染分为感染组(31例)和无感染组(226例)。比较两组基线资料及清创前、后创面细菌计数及NF-κB信使RNA(mRNA)、JNK mRNA、PI3K mRNA水平;采用Pearson相关分析开放性骨折患者NF-κB mRNA、JNK mRNA、PI3K mRNA水平与创面细菌计数的相关性;绘制受试者工作特征(ROC)曲线分析创面细菌计数、NF-κB mRNA、JNK mRNA、PI3K mRNA对开放性骨折患者发生骨感染的诊断价值;采用危险度分析不同创面细菌计数、NF-κB mRNA、JNK mRNA、PI3K mRNA表达开放性骨折患者发生骨感染的情况。结果感染组和无感染组Gustilo分型、受伤至手术时间、骨折固定方式比例、合并糖尿病比例比较,差异均有统计学意义(P<0.05);两组清创后创面细菌计数及NF-κB mRNA、JNK mRNA、PI3K mRNA水平低于清创前,差异均有统计学意义(P<0.05);清创后,感染组创面细菌计数及NF-κB mRNA、JNK mRNA、PI3K mRNA水平高于无感染组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,清创前、后开放性骨折患者NF-κB mRNA、JNK mRNA、PI3K mRNA水平与创面细菌计数均呈正相关(P<0.05)。ROC曲线结果显示,创面细菌计数、NF-κB mRNA、JNK mRNA、PI3K mRNA诊断开放性骨折患者骨感染的曲线下面积(AUC)分别为0.807、0.742、0.807、0.766,灵敏度分别为87.10%、61.29%、61.29%、67.74%,特异度分别为65.04%、88.63%、93.36%、74.41%,以上4项指标联合诊断骨感染的AUC为0.924,灵敏度为83.87%;特异度为89.10%。创面细菌计数及NF-κB mRNA、JNK mRNA、PI3K mRNA表达阳性患者骨感染的相对风险是阴性患者的9.616、7.459、10.385、4.732倍,差异均有统计学意义(P<0.05)。结论创Objective To investigate the value of wound bacterial count and nuclear factor-κB(NF-κB)/c-Jun N-terminal kinase(JNK)/phosphoinositol 3-kinase(PI3K)inflammatory signaling pathway-related factors in predicting bone infection in patients with open fracture before and after debridement.Methods A total of 257 patients with open fracture enrolled in Dazhou Central Hospital from January 2020 to August 2023 were selected and divided into infected group(31 cases)and non-infected group(226 cases)according to whether or not bone infection occurred.Baseline data,wound bacterial count and NF-κB messenger RNA(mRNA),JNK mRNA and PI3K mRNA levels before and after debridement were compared between the two groups;Pearson′s correlation was used to analyze the correlation of NF-κB mRNA,JNK mRNA and PI3K mRNA levels with bacterial count;receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of wound bacterial count,NF-κB mRNA,JNK mRNA and PI3K mRNA on bone infection;the risk analysis was used to analyze the relative risk of bone infection in patients with different wound bacterial count,NF-κB mRNA,JNKmRNA and PI3K mRNA.Results Gustilo classification,time from injury to operation,proportion of different fixation method,proportion of combined diabetes mellitus between the infected group and the non-infected group showed statistically significant differences(P<0.05).Wound bacterial count and NF-κB mRNA,JNK mRNA,PI3K mRNA levels in both groups after debridement were lower than those before debridement,and the differences were statistically significant(P<0.05);after debridement,the bacterial count and NF-κB mRNA,JNK mRNA,PI3K mRNA levels in the infected group were higher than those in the non-infected group,with statistically significant differences(P<0.05).The results of the Pearson′s correlation analysis showed that there was a positive correlation of NF-κB mRNA,JNK mRNA,PI3K mRNA levels with bacterial counts before and after debridement(P<0.05).The results of ROC curve showed that the area

关 键 词：开放性骨折 清创 细菌计数 核因子-κB c-Jun N-末端激酶 磷酸酰肌醇3-激酶 骨感染 诊断价值 

分 类 号：R683.4[医药卫生—骨科学] R446.5[医药卫生—外科学]