耐碳青霉烯肠杆菌科细菌血流感染患者外周血淋巴细胞自噬特征及其意义

doi:10.3969/j.issn.1673-8640.2024.08.007

摘要/Abstract

摘要：

目的分析耐碳青霉烯肠杆菌科细菌（CRE）血流感染（BSI）患者外周血淋巴细胞自噬特征及其临床意义。方法选取2019年6月—2022年6月南通市第二人民医院125例CRE-BSI患者（耐药组）和130例碳青霉烯类敏感细菌BSI患者（敏感组），以同期105名健康志愿者作为对照组。比较3个组外周血淋巴细胞自噬标志基因Beclin-1、LC3、Atg5a的mRNA水平差异。收集耐药组相关临床资料，比较死亡患者、存活患者临床特征和Beclin-1、Atg5a、LC3的mRNA水平的差异。采用Logistic回归分析评价耐药组患者死亡的影响因素。结果耐药组外周血淋巴细胞Beclin-1、LC3、Atg5a的mRNA水平低于敏感组和对照组（P<0.05）。耐药组外周血淋巴细胞Beclin-1、LC3、Atg5a的mRNA水平与急性生理和慢性健康评分Ⅱ（APACHE Ⅱ）评分、白细胞计数（WBC）、超敏C反应蛋白（hs-CRP）、降钙素原（PCT）水平均呈负相关（P<0.05）。耐药组死亡患者和存活患者之间外周血淋巴细胞Beclin-1、LC3、Atg5a的mRNA水平和年龄、呼吸道来源感染、合并感染性休克发生率，以及hs-CRP、PCT、APACHE Ⅱ评分差异均有统计学意义（P<0.05）。外周血淋巴细胞Beclin-1、LC3的mRNA水平和呼吸道来源感染、合并感染性休克、APACHE Ⅱ评分是耐药组患者死亡的危险因素（P<0.05）。结论 CRE-BSI患者外周血淋巴细胞自噬减弱与病情加重、预后不良有关。

关键词: 耐碳青霉烯肠杆菌科细菌, 血流感染, 淋巴细胞, 自噬, 预后

Abstract:

Objective To analyze the characteristics and clinical significance of autophagy in peripheral blood lymphocytes of patients with carbapenem-resistant Enterobacteriaceae（CRE）-bloodstream infection（BSI）. Methods Totally，125 patients with CRE-BSI（drug-resistant group） and 130 patients with carbapenem-sensitive bacterium-BSI（drug-sensitive group） were enrolled from the Second People's Hospital of Nantong from June 2019 to June 2022，and 105 healthy subjects were enrolled as control group. The mRNA expression levels of autophagy marker genes（Beclin-1，LC3 and Atg5a） in peripheral blood lymphocytes were determined，and the differences were compared. The clinical data of drug-resistant group were collected. The differences of clinical characteristic and Beclin-1，Atg5a，LC3 mRNA levels between death and survival patients were compared. Logistic regression analysis was used to evaluate the prognostic factors in drug-resistant group. Results The Beclin-1，LC3 and Atg5a mRNA levels of peripheral blood lymphocytes in drug-resistant group were lower than those in drug-sensitive group and control group（P<0.05）. Beclin-1，LC3 and Atg5a mRNA levels in peripheral blood lymphocytes in drug-resistant group were negatively correlated with acute physiological and chronic health evaluation Ⅱ（APACHE Ⅱ） score，white blood cell（WBC） count，high-sensitivity C-reactive protein（hs-CRP） and procalcitonin（PCT） levels（P<0.05）. There was statistical significance in Beclin-1，LC3 and Atg5a mRNA levels and age，respiratory tract infection，septic shock，hs-CRP，PCT and APACHE Ⅱ scores between death and survival patients in drug-resistant group（P<0.05）. Beclin-1 and LC3 mRNA levels in peripheral blood lymphocytes，respiratory tract infection，septic shock and APACHE Ⅱ score were the influential factors for death in drug-resistant group（P<0.05）. Conclusions The weakened autophagy of peripheral blood lymphocytes in CRE-BSI patients is related to disease aggravation and poor prognosis.

Key words: Carbapenem-resistant Enterobacteriaceae, Bloodstream infection, Lymphocyte, Autophagy, Prognosis

中图分类号:

R378.99

黄琳玲, 许美蓉, 沈晓雯, 顾玲莉, 沈红梅. 耐碳青霉烯肠杆菌科细菌血流感染患者外周血淋巴细胞自噬特征及其意义[J]. 检验医学, 2024, 39(8): 759-763.

HUANG Linling, XU Meirong, SHEN Xiaowen, GU LingLi, SHEN Hongmei. Changes and significance of autophagy in peripheral blood lymphocytes of patients with carbapenem-resistant Enterobacteriaceae-bloodstream infection[J]. Laboratory Medicine, 2024, 39(8): 759-763.

图/表 5

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组别	例数	Beclin-1 mRNA	LC3 mRNA	Atg5a mRNA
耐药组	125	0.58±0.07^*#	0.51±0.05^*#	0.71±0.09^*#
敏感组	130	0.74±0.10^*	0.81±0.11^*	0.83±0.12^*
对照组	105	1.00±0.15	1.00±0.19	1.00±0.18
F值		34.835	57.115	45.345
P值		<0.001	<0.001	<0.001

组别	例数	Beclin-1 mRNA	LC3 mRNA	Atg5a mRNA
耐药组	125	0.58±0.07^*#	0.51±0.05^*#	0.71±0.09^*#
敏感组	130	0.74±0.10^*	0.81±0.11^*	0.83±0.12^*
对照组	105	1.00±0.15	1.00±0.19	1.00±0.18
F值		34.835	57.115	45.345
P值		<0.001	<0.001	<0.001

指标	Beclin-1 mRNA		LC3 mRNA		Atg5a mRNA
指标	r值	P值	r值	P值	r值	P值
APACHE Ⅱ评分	-0.341	0.018	-0.401	<0.05	-0.355	0.015
WBC	-0.362	0.015	-0.357	<0.05	-0.421	0.005
hs-CRP	-0.294	0.025	-0.324	<0.05	-0.392	0.009
PCT	-0.344	0.018	-0.409	<0.05	-0.385	0.009

指标	Beclin-1 mRNA		LC3 mRNA		Atg5a mRNA
指标	r值	P值	r值	P值	r值	P值
APACHE Ⅱ评分	-0.341	0.018	-0.401	<0.05	-0.355	0.015
WBC	-0.362	0.015	-0.357	<0.05	-0.421	0.005
hs-CRP	-0.294	0.025	-0.324	<0.05	-0.392	0.009
PCT	-0.344	0.018	-0.409	<0.05	-0.385	0.009

项目	例数	Beclin-1 mRNA	LC3 mRNA	Atg5a mRNA
死亡患者	93	0.40±0.07	0.38±0.05	0.60±0.08
存活患者	32	0.64±0.08	0.55±0.06	0.75±0.11
t值		15.091	14.390	7.088
P值		<0.001	<0.001	<0.001