Smad2、Smad3、TGF-β1、PCT对血液透析导管相关血流感染的诊断价值  

Values of Smad2,Smad3,TGF-β1 and PCT in diagnosis of catheter-related bloodstream infection in hemodialysis patients

作　　者：张衡[1] 姜南 费世枝[1] 李红波[1] 熊飞[1] ZHANG Heng;JIANG Nan;FEI Shi-zhi;LI Hong-bo;XIONG Fei(Wuhan First Hospital,Wuhan,Hubei 430022,China)

机构地区：[1]武汉市第一医院血液净化中心,湖北武汉430022

出　　处：《中华医院感染学杂志》2025年第2期198-201,共4页Chinese Journal of Nosocomiology

基　　金：湖北省卫健委科研课题(WJ2018F220);武汉市卫健委科研项目(WZ22Q27)。

摘　　要：目的探讨Smad2、Smad3、转化生长因子-β1(TGF-β1)、降钙素原(PCT)在血液透析导管相关血流感染(CRBSI)患者中的水平变化,为血液透析患者CRBSI的临床诊疗提供指导。方法选取348例武汉市第一医院2020年11月-2023年11月收治的行血液透析的中心静脉留置导管患者,根据有无CRBSI发生分为CRBSI感染组31例和CRBSI非感染组317例,分析CRBSI病原菌分布,比较感染组患者感染24h内且抗感染治疗前与同期非感染组患者外周血Smad2、Smad3、TGF-β1蛋白相对表达量及PCT水平,采用受试者工作特征(ROC)曲线分析四指标水平的诊断价值。结果31例血液透析CRBSI患者共培养出33株病原菌,大肠埃希菌(18.18%)是主要的革兰阴性菌,金黄色葡萄球菌(39.39%)是主要的革兰阳性菌。CRBSI感染组和CRBSI非感染组患者Smad2、Smad3、TGF-β1蛋白表达量及PCT水平比较有统计学意义(P<0.05),CRBSI感染组患者Smad2、Smad3、TGF-β1蛋白表达量及PCT水平分别为(1.14±0.37)、(1.02±0.33)、(1.29±0.42)及(1.31±0.42)μg/L。Smad2、Smad3、TGF-β1及PCT联合检测诊断血液透析患者CRBSI的曲线下面积(AUC)值为0.949,高于各指标单项检测(P<0.05)。结论血液透析CRBSI病原菌主要为大肠埃希菌和金黄色葡萄球菌,血液透析患者发生CRBSI后Smad2、Smad3、TGF-β1、PCT呈高表达,四者联合对血液透析患者CRBSI诊断价值较高。OBJECTIVE To explore the changes of Smad2,Smad3,transforming growth factor-β1(TGF-β1)and procalcitonin(PCT)in the hemodialysis patients with catheter-related bloodstream infection(CRBSI)so as to provide guidance for clinical diagnosis and treatment of the hemodialysis patients with CRBSI.METHODS A total of 348 hemodialysis patients who were treated with central venous indwelling catheter in Wuhan First Hospital from Nov.2020 to Nov.2023 were enrolled in the study and were divided into the CRBSI group with 31 cases and the non-CRBSI group with 317 cases according to the status of CRBSI.The distribution of pathogens isolated from the patients with CRBSI was analyzed.The relative expression levels of peripheral blood Smad2,Smad3 and TGF-β1 proteins and the PCT level were compared between the infection group and the non-infection group within 24 hours of infection and before the anti-infection treatment.The diagnostic values of the four indexes were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 33 strains of pathogens were isolated from the 31 hemodialysis patients with CRBSI;Escherichia coli(18.18%)was the predominant species of gram-negative bacteria,and Staphylococcus aureus(39.39%)was dominant among gram-positive bacteria.There were significant differences in the expression levels of Smad2,Smad3,TGF-β1 proteins and the PCT level between the CRBSI group and the non-CRBSI group(P<0.05).The expression levels of Smad2,Smad3,TGF-β1 and PCT level of the CRBSI group were(1.14±0.37),(1.02±0.33),(1.29±0.42)and(1.31±0.42)μg/L,respectively.The area under the curve(AUC)of the joint detection of Smad2,Smad3,TGF-β1 and PCT was 0.949 in diagnosis of CRBSI of the hemodialysis patients,significantly higher than that of the single detection(P<0.05).CONCLUSIONS E.coli and S.aureus are the main species of pathogens isolated from the hemodialysis patients with CRBSI.The hemodialysis patients with CRBSI show the high expressions of Smad2,Smad3,TGF-β1 and PCT.The joint detection of the fo

关 键 词：血液透析 导管相关血流感染 致病菌 转化生长因子-β1/Smads信号通路蛋白 降钙素原 

分 类 号：R459.5[医药卫生—治疗学]