GSTM1基因多态性与儿童急性淋巴细胞白血病医院感染的关联  

Association of GSTM1 gene polymorphism with hospital-associated infections in children with acute lymphoblastic leukemia

作　　者：薛永梅 杨翊 赵伟青 高彬昌[1] XUE Yongmei;YANG Yi;ZHAO Weiqing;GAO Binchang(Qingdao Hiser Hospital Affiliated of Qingdao University(Qingdao Traditional Chinese Medicine Hospital),Qingdao,Shandong 266033,China)

机构地区：[1]青岛大学附属青岛市海慈医院(青岛市中医医院)儿科,山东青岛266033 [2]青岛大学附属青岛市海慈医院(青岛市中医医院)影像科,山东青岛266033 [3]青岛大学附属青岛市海慈医院(青岛市中医医院)消化中心,山东青岛266033

出　　处：《中华医院感染学杂志》2025年第3期436-440,共5页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展基金资助项目(2020003041040)。

摘　　要：目的探究谷胱甘肽硫转移酶M1(GSTM1)基因多态性与儿童急性淋巴细胞白血病医院感染的关联,并分析病原菌的耐药性以及微炎症状态对其预测价值。方法选取2021年1月—2024年1月青岛市中医医院收治的急性淋巴细胞白血病患儿115例为研究对象,根据医院感染情况分为感染组56例,非感染组59例。统计感染患儿病原菌及其药敏结果;比较两组GSTM1基因多态性及CD64、降钙素原(PCT)、超敏C-反应蛋白(hsCRP)、淀粉样蛋白A(SAA)水平;采用受试者工作特征(ROC)曲线分析CD64、PCT、hs-C RP、SAA对儿童急性淋巴细胞白血病医院感染的预测价值。结果56例急性淋巴细胞白血病医院感染患儿检出72株病原菌,革兰阴性菌42株占58.33%,革兰阳性菌28株占38.89%,以大肠埃希菌、金黄色葡萄球菌为主。大肠埃希菌主要对氨苄西林耐药率较高(>90%),对阿米卡星敏感;金黄色葡萄球菌对青霉素G耐药率较高(100.00%),对庆大霉素、利福平、利奈唑胺、万古霉素较为敏感。感染组GSTM1缺失基因型分布占比高于非感染组(P=0.012)。感染组CD64、PCT、hs-CRP、SAA分别为(69.45±20.88)%、(0.71±0.22)ng/ml、(12.26±3.94)mg/L、(117.78±36.57)mg/L高于非感染组(P<0.05)。ROC曲线显示联合检测诊断急性淋巴细胞白血病院内感染患儿的曲线下面积(AUC)为0.935高于单独检测(P<0.05),且联合检测的敏感度、特异度为91.07%、84.75%。结论急性淋巴细胞白血病医院感染患儿CD64、PCT、hs-CRP、SAA水平表达异常,且四者联合检测可提高对医院感染的诊断价值,GSTM1基因多态性与急性淋巴细胞白血病患儿医院感染有关。OBJECTIVE To investigate the association of glutathione S-transferase M1(GSTM1)gene polymorphism with hospital-associated infection in children with acute lymphoblastic leukemia,and to analyze the drug resistance of pathogens and the predictive value of micro-inflammatory state.METHODS One hundred and fifteen children with acute lymphoblastic leukemia admitted to Qingdao Hospital of Traditional Chinese Medicine from Jan.2021 to Jan.2024 were selected as the research subjects,and were divided into 56 cases in the infection group and 59 cases in the non-infection group according to the situation of hospital-associated infection.The pathogenic bacteria and drug sensitivity results of the infected children were analyzed.The GSTM1 gene polymorphism and levels of CD64,procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP)and amyloid A(SAA)were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CD64,PCT,hs-CRP and SAA for hospital-associated infection in children with acute lymphoblastic leukemia.RESULTS A total of 72 strains of pathogenic bacteria were detected in 56 children with acute lymphoblastic leukemia hospital-acquired infections,of which 42 strains of gram-negative bacteria accounted for 58.33%and 28 strains of gram-positive bacteria accounted for 38.89%,with Escherichia coli and Staphylococcus aureus predominating.The drug resistance rate of Escherichia coli to ampicillin was more than 90%,and it was sensitive to amikacin.Staphylococcus aureus was highly resistant to penicllin G(100.00%)and sensitive to gentamicin,rifampicin,linezolid and vancomycin.The percentage of distribution of GSTM1 null genotype in the infection group was higher than that in the non-infection group(P=0.012).The levels of CD64,PCT,hs-CRP,and SAA in the infection group were(69.45±20.88)%,(0.71±0.22)ng/ml,(12.26±3.94)mg/L and(117.78±36.57)mg/L,respectively,which were higher than those in the non-infection group(P<0.05).ROC curve showed that the area under the c

关 键 词：急性淋巴细胞白血病 医院感染 谷胱甘肽硫转移酶M1 基因多态性 药敏试验 CD64 降钙素原 超敏C-反应蛋白 淀粉样蛋白A 预测价值 

分 类 号：R733.7[医药卫生—肿瘤]