四肢骨折患者术后感染的病原菌分布及血清TIRAP、CD34、SDF-1α的变化  

Distribution of pathogens and changes in serum TIRAP,CD34,and SDF-1αlevels in postoperative infections in patients with limb fractures

作　　者：胡迎华 郑冲 卢伟杰[2] HU Yinghua;ZHENG Chong;LU Weijie(Department of Orthopedics,Xiangyang Central Hospital,Xiangyang 441000,China;Department of Orthopedics,First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]襄阳市中心医院骨科,襄阳441000 [2]广州医科大学附属第一医院骨科,广州510000

出　　处：《中国真菌学杂志》2025年第1期28-33,共6页Chinese Journal of Mycology

基　　金：广州市科技计划项目(K2022010103)。

摘　　要：目的 探究四肢骨折患者术后感染的病原菌分布以及血清Toll/白介素-1受体相关蛋白(Toll/interleukin-1 receptor associated protein,TIRAP)、CD34、基质细胞衍生因子-1α(stromal cell-derived factor-1α,SDF-1α)对感染的预测价值。方法 选取2021年8月—2024年2月期间本院接治的104例四肢骨折术后感染患者为感染组,同期104例四肢骨折术后未感染患者为对照组。对感染患者的切口/伤口分泌物进行病原菌分离鉴定,采用ELISA法检测血清TIRAP、CD34、SDF-1α水平;采用logistic回归分析四肢骨折患者术后感染影响因素;采用ROC曲线分析指标对感染的预测价值,采用Z检验比较AUC;采用Pearson法分析不同变量间的相关性。结果 104例感染患者中共分离出病原菌136株,革兰阳性菌46株(33.82%),革兰阴性菌57株(41.91%),念珠菌33株(24.27%)。感染组术后第3天血清TIRAP水平及TNF-α、CRP、糖尿病患者比例高于对照组,CD34、SDF-1α水平低于对照组(P <0.05)。TIRAP(OR=2.910)是四肢骨折患者术后感染的独立危险因素,CD34(OR=0.745)、SDF-1α(OR=0.802)是四肢骨折患者术后感染的保护因素(P <0.05)。TIRAP、CD34、SDF-1α单独预测四肢骨折患者术后感染AUC低于三者联合AUC(Z=3.984、3.059、3.351,P <0.05)。感染组创面愈合时间、创面愈合评分高于对照组(P <0.05)。感染组患者血清TIRAP与创面愈合时间、创面愈合评分呈正相关,CD34、SDF-1α与创面愈合时间、创面愈合评分呈负相关(P <0.05)。结论 四肢骨折患者术后感染以金黄色葡萄球菌、铜绿假单胞菌、白念珠菌为主,感染患者血清TIRAP水平升高,CD34、SDF-1α水平降低,各指标表达与愈合情况密切相关。Objective To investigate the distribution of pathogens in postoperative infections patients with limb fractures,and the predictive value of serum Toll/interleukin-1 receptor associated protein(TIRAP),CD34,and stromal cell-derived factor-1α(SDF-1α)for infections.Methods A total of 104 limb fractures patients with postoperative infection treated in our hospital between August 2021 and February 2024 were regarded as the infection group,while 104 limb fractures patients without postoperative infection during the same period were selected as the control group.The samples from the incision/wound secretions of infected patients were subjected to pathogen isolation and identification.ELISA method was applied to detect serum TIRAP,CD34,and SDF-1αlevels.Logistic regression was applied to analyze the influencing factors of postoperative infection in patients with limb fractures.ROC curve was applied to analyze the predictive value of indicators for infection.Z-test was applied to compare AUC.Pearson method was applied to analyze the correlation between different variables.Results A total of 136 pathogenic bacteria were isolated from 104 infected patients,including 46 strains of Gram positive bacteria(33.82%),57 strains of Gram negative bacteria(41.91%),and 33 strains of Candida(24.27%).The serum TIRAP level, TNF-α, CRP and the proportion of diabetes patients in the infection group were higher than those in the control group on the third day after operation, while the levels of CD34 and SDF-1α were lower than those in the control group (P<0.05). TIRAP (OR=2.910) was an independent risk factor for postoperative infection in patients with limb fractures, while CD34 (OR=0.745) and SDF-1α (OR=0.802) were protective factors for postoperative infection in patients with limb fractures (P<0.05). The AUC of TIRAP, CD34, and SDF-1α alone in predicting postoperative infection in patients with limb fractures was lower than the AUC of the three combination (Z=3.984, 3.059, 3.351, P<0.05). The wound healing time and wound healing s

关 键 词：四肢骨折 感染 病原菌 Toll/白介素-1受体相关蛋白 CD34 基质细胞衍生因子-1Α 

分 类 号：R619[医药卫生—外科学]