首页|长期卧床患者肺部感染危险因素及其TLR7 mRNA和IL-23与IL-17的预测价值

长期卧床患者肺部感染危险因素及其TLR7 mRNA和IL-23与IL-17的预测价值

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目的 脊柱手术后长期卧床患者肺部感染患者危险因素及其Toll样受体7(TLR7)和白细胞介素-23(IL-23)与IL-17信号通路的预测价值。方法 收集2019年1月—2022年9月绍兴文理学院附属医院收治的脊柱手术后长期卧床未并发肺部感染患者123例设为未感染组，选取同期于医院接受治疗的33例脊柱手术后长期卧床并发肺部感染患者作为感染组，采用多因素Logistic回归分析归纳脊柱手术后长期卧床患者肺部感染的危险因素，采用受试者工作特征(ROC)曲线分析TLR7、IL-23、IL-17信号通路对脊柱手术后长期卧床患者肺部感染的预测价值。结果 多因素Logistic回归分析结果显示，慢性肺部疾病、合并糖尿病、机械通气均为脊柱手术后长期卧床患者肺部感染的危险因素(OR=3。323，2。646，2。259，P＜0。05);联合预测脊柱手术后长期卧床患者肺部感染发生的曲线下面积(AUC)值均高于TLR7 mRNA、IL-23、IL-17单独检测(P＜0。05);TLR7 mRNA及联合敏感度高于IL-23、IL-17(P＜0。05);IL-23及联合检测特异度高于TLR7 mRNA、IL-17(P＜0。05)，IL-17特异度高于TLR7 mRNA(P＜0。05)。结论 脊柱手术后长期卧床患者肺部感染发生的易感因素包括有慢性肺部疾病、合并糖尿病、机械通气，同时TLR7/IL-23/IL-17信号通路相关指标联合检测对脊柱手术后长期卧床患者肺部感染发生具有较好的预测价值，临床可根据其相关易感因素和保护因素对脊柱手术后长期卧床患者进行针对性干预或治疗，降低患者肺部感染发生的风险。
Risk factors for pulmonary infections in long-term bedridden patients after spinal surgery and the predictive value of TLR7 mRNA and IL-23 and IL-17
OBJECTIVE To investigate the risk factors for pulmonary infections in long-term bedridden patients af-ter spinal surgery and the predictive value of Toll-like receptor 7(TLR7),interleukin-23(IL-23)and IL-17 signa-ling pathway.METHODS Totally 123 patients who were admitted to the Affiliated Hospital of Shaoxing Universi-ty of Arts and Sciences from Jan.2019 to Sep.2022,who were bedridden for a long time period after spinal sur-gery without complication of pulmonary infections,were collected as the uninfected group,and 33 patients who were treated in the hospital during the same period,and who were bedridden for a long time period after spinal surgery with complication of pulmonary infections,were selected as the infected group.The risk factors for pul-monary infection for patients who were bedridden for a long time after spinal surgery were summarized by multi-variate Logistic regression analysis,and the predictive value of the signaling pathway of TLR7,IL-23 and IL-17 on the pulmonary infections of patients who were bedridden for a long period of time were analyzed by receiver's operating characteristics(ROC)curve.RESULTS The results of multivariate logistic regression analysis showed that chronic pulmonary disease,combined diabetes mellitus and mechanical ventilation were all the risk factors for pulmonary infection in patients who were bedridden for a long time after spinal surgery(OR=3.323,2.646,2.259,P＜0.05).The area under the curve(AUC)value of the combined detection for the prediction of pulmo-nary infection in patients who have been bedridden for a long time after spinal surgery was higher than that of TLR7 mRNA,IL-23 and IL-17 alone(P＜0.05).TLR7 mRNA and the combined sensitivity were higher than those of IL-23 and IL-17(P＜0.05).The specificity of IL-23 and its combination was higher than that of TLR7 mRNA and IL-17(P＜0.05),and the specificity of IL-17 was higher than that of TLR7 mRNA(P＜0.05).CONCLUSION The susceptible factors for the occurrence of pulmonary infection in long-term bedridden patients after spinal surgery included chronic pulmonary disease,combined diabetes mellitus and mechanical ventilation,while the combination of TLR7/IL-23/IL-17 signaling pathway-related indexes had good predictive value for the occurrence of pulmonary infection in long-term bedridden patients after spinal surgery.Clinically,targeted inter-vention or treatment can be carried out for long-term bedridden patients after spinal surgery according to their rele-vant susceptible factors and protective factors to reduce the risk of pulmonary infection.

Spinal surgeryLong-term bedriddenPulmonary infectionSusceptible factorToll-like receptor 7Interleukin-23Interleukin-17Signal pathwayPredictive value

黄艳、马乐娟、邢冬、钱万峰、寿月华、沈海良

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脊柱手术 长期卧床 肺部感染 易感因素 Toll样受体7 白细胞介素-23 白细胞介素-17 信号通路 预测价值

浙江省医药卫生科技计划基金资助项目

2023KT1274

2024

10.11816/cn.ni.2024-236154

中华医院感染学杂志
中华预防医学会 中国人民解放军总医院

中华医院感染学杂志

CSTPCD北大核心
影响因子：1.885
ISSN：1005-4529
年,卷(期)：2024.34(4)
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