梗阻性黄疸PTCD术后胆道感染病原菌及CD36/mTORC1信号转导通路活化状态  

Pathogens and activation status of CD36/mTORC1 transduction signaling pathways of obstructive jaundice patients with biliary tract infection after PTCD

作　　者：李雯[1] 原强[2] 赵建琴[3] LI Wen;YUAN Qiang;ZHAO Jian-qin(Suzhou University Affiliated Second Hospital,Suzhou,Jiangsu 215004,China)

机构地区：[1]苏州大学附属第二医院导管室,江苏苏州215004 [2]苏州大学附属第二医院介入科,江苏苏州215004 [3]苏州大学附属第二医院普外科,江苏苏州215004

出　　处：《中华医院感染学杂志》2025年第1期70-74,共5页Chinese Journal of Nosocomiology

基　　金：江苏省卫生健康委科研项目(M2020075);苏州市科技局医学应用基础研究(SYS2020141,SKJY2021075,SKY2023171)。

摘　　要：目的探讨梗阻性黄疸经皮肝穿刺胆道引流(PTCD)术后胆道感染患者CD36/雷帕霉素靶蛋白复合物1(mTORC1)信号转导通路的活化状态及病原菌分布特征。方法选取2020年11月-2023年12月苏州大学附属第二医院收治的梗阻性黄疸行PTCD术后胆道感染患者69例为感染组,同期术后未感染患者281例为未感染组,分析术后胆道感染病原菌分布及主要病原菌的耐药情况,比较两组患者外周血CD36、磷酸化蛋白激酶(pAKT)、磷酸化p7036K、雷帕霉素靶蛋白(mTOR)水平,绘制受试者工作特征(ROC)曲线分析CD36/mTORC1信号转导通路关键因子对梗阻性黄疸患者PTCD术后胆道感染的诊断价值。结果69例感染患者共检出病原菌75株,其中革兰阴性菌占比81.33%,以大肠埃希菌、铜绿假单胞菌占比最高,分别为42.67%、26.67%,两者对氨苄西林、头孢克洛、头孢噻肟、环丙沙星的耐药率均较高,对碳青霉烯类抗菌药物耐药率较低;感染组患者CD36、P-AKT、P-p7036K、mTOR水平均高于未感染组(P<0.05),ROC曲线分析结果显示,CD36/mTORC1信号转导通路关键因子联合诊断梗阻性黄疸患者PTCD术后胆道感染的曲线下面积(AUC)值为0.931,敏感度、特异度为88.41%、85.77%。结论革兰阴性菌为梗阻性黄疸患者PTCD术后胆道感染主要致病菌,感染患者CD36/mTORC1信号转导通路关键因子呈异常高表达,各因子联合对术后胆道感染的诊断价值更高。OBJECTIVE To explore the activation status of mammalian target of rapamycin complex 1(mTORC1)signaling transduction pathways of the obstructive jaundice patients who had biliary tract infection after percutaneous transluminal cholangial drainage(PTCD)and analyze the distribution of pathogens.METHODS A total of 69 obstructive jaundice patients who underwent PTCD and had postoperative biliary tract infection in Suzhou University Affiliated Second Hospital from Nov.2020 to Dec.2023 were assigned as the infection group,meanwhile,281 patients who did not have postoperative infection were chosen as the no infection group.The distribution of pathogens causing the postoperative biliary tract infection and drug resistance rates of the major species of pathogens were observed.The levels of peripheral blood CD36,phosphorylated protein kinase(p-AKT),phosphorylated p7036K and mammalian target of rapamycin(mTOR)were compared between the two groups of patients.The values of the key factors of CD36/mTORCl signaling transduction pathways in diagnosis of postoperative biliary tract infection in the obstructive jaundice patients undergoing PTCD were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 75 strains of pathogens were isolated from the 69 patients with the infection,81.33%of which were gram-negative bacteria;Escherichia coli and Pseudomonas aeruginosa were the predominant species,accounting for 42.67%and 26.67%,respectively.The drug resistance rates of the two species of pathogens to ampicillin,cefaclor,cefotaxime and ciprofloxacin were relatively high,while the drug resistance rates to carbapenems were relatively low.The levels of CD36,P-AKT,P-p7036K and mTOR of the infection group were higher than those of the no infection group(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the joint detection of the key factors of CD36/mTORC1 signaling transduction pathways was O.931 in diagnosis of the postoperative biliary tract infection in the obstructive jaundice patients und

关 键 词：梗阻性黄疸 经皮肝穿刺胆道引流 胆道感染 CD36 雷帕霉素靶蛋白复合物1 病原菌 

分 类 号：R619.3[医药卫生—外科学]