失代偿期肝硬化并发自发性细菌性腹膜炎患者危险因素和PBMC CD36/mTORC1信号通路变化研究*

doi:10.3969/j.issn.1672-5069.2024.01.021

摘要/Abstract

摘要： 目的探讨失代偿期肝硬化患者并发自发性细菌性腹膜炎(SBP)的危险因素,分析患者外周血单个核细胞(PBMC)分化抗原(CD)36/哺乳动物雷帕霉素靶蛋白1(mTORC1)信号通路水平变化。方法 2020年7月～2023年12月我院诊治的失代偿期肝硬化患者82例,其中并发SBP者43例。取腹水培养,进行细菌鉴定,采用PCR法检测PBMC CD36/mTORC1 mRNA水平。应用多因素Logistic回归分析影响失代偿期肝硬化患者并发SBP的危险因素。结果在本组43例SBP患者中,分离出病原菌8株(9.8%),其中科氏葡萄球菌和溶血葡萄球菌各1株,大肠埃希菌2株,肺炎克雷伯菌2株和阴沟杆菌2株;SBP患者既往SBP发生史、血清总胆红素、血清白蛋白、INR、MELD评分及PBMC CD36和mTORC1 mRNA水平分别为51.2%、(45.7±5.2)μmol/L、(21.7±3.1)g/L、(1.5±0.5)、(24.9±7.5)、(3.2±0.8)和(2.4±0.7),与肝硬化组【分别为18.0%、(12.3±1.4)μmol/L、(35.3±5.4)g/L、(1.2±0.3)、(12.8±3.7)、(1.4±0.5)和(1.1±0.4)】比,差异显著(P<0.05);多因素Logistic回归分析结果显示,SBP发生史、血清总胆红素、ALB、MELD评分及PBMC CD36和mTORC1水平为影响失代偿期肝硬化并发SBP的独立危险因素(P＜0.05)。结论失代偿期肝硬化并发SBP患者PBMC CD36/mTORC1信号通路表达上调,其在SBP发生过程中的作用还有待于进一步研究。

关键词: 失代偿期肝硬化, 自发性细菌性腹膜炎, 分化抗原36/哺乳动物雷帕霉素靶蛋白1信号通路

Abstract: Objective The purpose of this study was to investigate the risk factors of spontaneous bacterial peritonitis (SBP) and peripheral blood mononuclear cell (PBMC) cluster of differentiation (CD) 36/mammalian target of rapamycin 1 (mTORC1) signal pathway expression in patients with decompensated cirrhosis. Methods 82 patients with decompensated liver cirrhosis were encountered in our hospital between July 2020 and December 2023. Ascites bacteria was cultured and characterized routinely. The PBMCs were separated and the CD36/mTORC1 mRNA was detected by real-time fluorescent quantitative PCR. The multivariate Logistic regression analysis was applied to screen the risk factors for SBP occurrence in patients with decompensated cirrhosis. Results The complications of SBP was found in 43 cases out of our patients with decompensated liver cirrhosis and eight strains (9.8%)of bacteria were successfully isolated, including one strain of Staphylococcus coriolis, one strain of Hemolytic Staphylococcus, two strains of Escherichia coli, two strains of Klebsiella pneumonia and two strains of Enterobacter cloacae; the incidence of past SBP, serum total bilirubin, albumin, international normalized ratio, the model of end-stage liver disease score, the PBMC CD36 mRNA and mTORC1 mRNA in patients with SBP were 51.2%, (45.7±5.2)μmol/L, (21.7±3.1)g/L, (1.5±0.5), (24.9±7.5), (3.2±0.8) and (2.4±0.7), all significantly different compared to [18.0%,(12.3±1.4)μmol/L, (35.3±5.4)g/L, (1.2±0.3), (12.8±3.7), (1.4±0.5) and (1.1±0.4), respectively, P<0.05] in patients with liver cirrhosis; the multivariate Logistic regression analysis showed that the past SBP, serum bilirubin, albumin, MELD score as well as PBMC CD36 and mTORC1 levels were all the independent risk factors for the occurrence of SBP in patients with decompensated liver cirrhosis (P＜0.05). Conclusion The PBMC CD36/mTORC1 signal pathway is up-regulated in patients with decompensated cirrhosis and complicated SBP, and the mechanism involved in the pathogenesis needs further investigation.

Key words: Decompensated liver cirrhosis, Spontaneous bacterial peritonitis, Cluster of differentiation 36/mammalian target of rapamycin 1 signal pathway

张迎迎, 魏珂乐, 丁鹤, 郭慧杰, 崔轶, 王昳. 失代偿期肝硬化并发自发性细菌性腹膜炎患者危险因素和PBMC CD36/mTORC1信号通路变化研究^*[J]. 实用肝脏病杂志, 2024, 27(1): 80-83.

Zhang Yingying, Wei Kele, Ding He, et al. Risk factors of spontaneous bacterial peritonitis and peripheral blood mononuclear cell CD36/mTORC1 signal pathway expression in patients with decompensated cirrhosis[J]. Journal of Practical Hepatology, 2024, 27(1): 80-83.

参考文献

[1] 崔丽娜,王秀芳,孙瑞青,等. 自体外周血干细胞回输对失代偿期肝硬化患者远期预后影响的研究. 中华肝脏病杂志,2022,30(3):279-284.
[2] 贾新勇,栗朋辉,郭改玲,等. 失代偿期乙肝肝硬化患者碳青霉烯类耐药大肠埃希菌医院感染的危险因素及其耐药基因. 中华医院感染学杂志,2022,32(10):1478-1481.
[3] Mattos AA, Wiltgen D, Jotz RF, et al. Spontaneous bacterial peritonitis and extraperitoneal infections in patients with cirrhosis. Ann Hepatol, 2020, 19(5):451-457.
[4] Sandmann L, Dörge P, Wranke A, et al. Treatment strategies for patients with decompensated liver cirrhosis due to hepatitis C virus infection eligible for liver transplantation: real-life data from five German transplant centers. Eur J Gastroenterol Hepatol,2019,31(8):1049-1056.
[5] Singla P, Dalal P, Kaur M,et al. Bile acid oligomers and their combination with antibiotics to combat bacterial infections. J Med Chem,2018,61(22):10265-10275.
[6] Komolafe O, Roberts D, Freeman SC, et al. Antibiotic prophylaxis to prevent spontaneous bacterial peritonitis in people with liver cirrhosis: a network meta-analysis. Cochrane Database Syst Rev, 2020 ,1(1):13125.
[7] Andrieux P, Chevillard C, Cunha-Neto E, et al. Mitochondria as a cellular hub in infection and inflammation. Int J Mol Sci, 2021, 22(21):11338.
[8] Lobo AM, Agelidis AM, Shukla D. Pathogenesis of herpes simplex keratitis: The host cell response and ocular surface sequelae to infection and inflammation. Ocul Surf, 2019, 17(1):40-49.
[9] Bhat A ,Das S ,Yadav G ,et al.Hyperoxidized albumin modulates platelets and promotes inflammation through CD36 receptor in severe alcoholic hepatitis. Hepatol Commun,2019,4(1):50-65.
[10] Deng Z, Chen M, Liu Y, et al. A positive feedback loop between mTORC1 and cathelicidin promotes skin inflammation in rosacea. EMBO Mol Med, 2021, 13(5):13560.
[11] 秦波,郭树华.自发性细菌性腹膜炎.中华肝脏病杂志,2003,11(7):439-440.
[12] 中华医学会肝病学分会. 肝硬化诊治指南.实用肝脏病杂志,2019,22(6):770-792.
[13] 周小兵,李玉鑫,高方媛,等.肝硬化合并发自发性细菌性腹膜炎133例的危险因素分析.中华消化杂志,2019,39(4):268-270.
[14] Marciano S, Díaz JM, Dirchwolf M, et al. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies. Hepat Med, 2019,11:13-22.
[15] Lotte R, Courdurié A, Gaudart A, et al. Spontaneous bacterial peritonitis: the incremental value of a fast and direct bacterial identification from ascitic fluids inoculated in blood culture bottles by MALDI-TOF MS for a better management of patients. Microorganisms, 2022, 10(6):1188.
[16] 谭志洁,赵静,刘文兴,等.肝硬化腹水患者并发自发性细菌性腹膜炎病原菌与影响因素分析.中华医院感染学杂志,2019,29(19):2953-2956.
[17] Kimmann M ,Tergast T L,Schultalbers M ,et al.Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis. PLoS ONE, 2019,14(8):e0220666.
[18] Prat L I ,Wilson P ,Freeman S C ,et al. Antibiotic treatment for spontaneous bacterial peritonitis in people with decompensated liver cirrhosis: A network meta-analysis. Cochrane Database Syst Rev,2019,16(9):CD013120.
[19] Klyachman L ,Schuster I P , Wang H,et al. S1502 a rare case of raoultella planticola-associated spontaneous bacterial peritonitis in a patient with decompensated cirrhosis. Am J Gastroenterol,2020,115(1):S757-S758.
[20] Liu K, Qiu D, Liang X, et al. Lipotoxicity-induced STING1 activation stimulates MTORC1 and restricts hepatic lipophagy. Autophagy, 2022, 18(4):860-876.

失代偿期肝硬化并发自发性细菌性腹膜炎患者危险因素和PBMC CD36/mTORC1信号通路变化研究^*

Risk factors of spontaneous bacterial peritonitis and peripheral blood mononuclear cell CD36/mTORC1 signal pathway expression in patients with decompensated cirrhosis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	邱婉春, 毛小荣, 邓乐风, 龚燕华, 孙雪, 李俊峰. 肝硬化并发肌肉减少症发生因素及其对自发性细菌性腹膜炎发生的影响^*[J]. 实用肝脏病杂志, 2023, 26(5): 674-677.
[2]	冯冬霞, 奚晶, 杨振斌, 刘亚芹, 胡茜莹. 乙型肝炎肝硬化并发自发性细菌性腹膜炎患者外周血单个核细胞NLRP3和Caspase-1水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2023, 26(5): 682-685.
[3]	丁闪闪, 丁凯, 姜宁. 索磷布韦联合维帕他韦治疗丙型肝炎肝硬化患者疗效及安全性分析^*[J]. 实用肝脏病杂志, 2023, 26(4): 536-539.
[4]	沈一芃, 祝峻峰. 肝硬化并发自发性细菌性腹膜炎临床研究进展^*[J]. 实用肝脏病杂志, 2022, 25(6): 909-912.
[5]	罗楠, 李荣宽. 肝硬化并发自发性细菌性腹膜炎诊治现状[J]. 实用肝脏病杂志, 2022, 25(5): 616-619.
[6]	龚豪, 黄丽, 张庆红, 李涛, 史秀岩. 应用尿微量白蛋白、β2-微球蛋白和N-乙酰-β-D氨基葡萄糖苷酶评估失代偿期肝硬化患者肾损伤效能研究^*[J]. 实用肝脏病杂志, 2022, 25(5): 681-684.
[7]	王菁, 毕宁, 方亮, 田园. 乙型肝炎肝硬化并发自发性细菌性腹膜炎患者CD64指数及血清sTREM-1和IL-6水平变化与肠黏膜屏障功能关系研究[J]. 实用肝脏病杂志, 2022, 25(1): 79-82.
[8]	刘玉玲, 甄增国, 王慧娟, 万秀敏, 郭振凯. 益生菌制剂对肝硬化并发自发性细菌性腹膜炎患者肠道屏障功能的影响^*[J]. 实用肝脏病杂志, 2021, 24(6): 867-870.
[9]	李翠茹, 武丽, 平采艳, 周红霞, 蔡志刚. 微生态制剂治疗乙型肝炎肝硬化并发自发性细菌性腹膜炎患者临床疗效分析^*[J]. 实用肝脏病杂志, 2020, 23(6): 845-848.
[10]	扈登财, 杜莉, 曹成红, 史晋洁, 李亚宁. 血清降钙素原和C-反应蛋白水平预测肝硬化患者发生自发性细菌性腹膜炎的价值分析[J]. 实用肝脏病杂志, 2020, 23(5): 699-702.
[11]	贺连栋, 曹淑琴, 韩灿, 陈有玺. 腹水浓缩回输治疗失代偿期肝硬化患者肾血流和血清血管活性因子水平的变化[J]. 实用肝脏病杂志, 2020, 23(5): 707-710.
[12]	王月圆, 王燕, 张丹丹. 奥曲肽辅助特利加压素治疗失代偿期肝硬化并发肝肾综合征患者疗效分析*[J]. 实用肝脏病杂志, 2019, 22(5): 684-687.
[13]	吴文豪, 符汉光, 陈朝琴. 肝硬化并发自发性细菌性腹膜炎患者临床特点、病原学和药敏结果分析*[J]. 实用肝脏病杂志, 2018, 21(3): 356-359.
[14]	赵宇, 祝瑜, 张代忠. 人脐带间充质干细胞肝内移植联合苦参素治疗失代偿期乙型肝炎肝硬化患者疗效与转归分析[J]. 实用肝脏病杂志, 2018, 21(3): 360-363.
[15]	王晓, 赵文霞. 夜间加餐干预可促进失代偿期肝硬化患者肝功能恢复[J]. 实用肝脏病杂志, 2018, 21(1): 112-113.