中国普通外科杂志2026，Vol.35Issue(2)：269-278,10.DOI:10.7659/j.issn.1005-6947.250284
恶性胆道梗阻介入术后胆道感染患者TLR2 mRNA、HDC和CD64表达特征及预测价值
Expression characteristics and predictive value of TLR2 mRNA,HDC,and CD64 for biliary infection after interventional therapy for malignant biliary obstruction
摘要
Abstract
Background and Aims:Biliary tract infection is a common complication after interventional treatment for malignant biliary obstruction(MBO),yet reliable early predictive markers are lacking.This study aimed to investigate the expression of Toll-like receptor 2(TLR2)mRNA,histidine decarboxylase(HDC),and neutrophil CD64 and evaluate their predictive value for postoperative biliary infection after DSA-guided biliary stent combined with radioactive seed chain implantation. Methods:A retrospective cohort of 285 patients with MBO who underwent DSA-guided biliary stent combined with radioactive seed chain implantation between January 2021 and February 2024 was analyzed.Patients were divided into an infection group(n=46)and a non-infection group(n=239)according to the occurrence of postoperative biliary infection.Baseline characteristics,inflammatory markers(CRP,PCT,and white blood cells),and the expression levels of TLR2 mRNA,HDC,and CD64 before surgery and on postoperative day 1 were compared.Pearson correlation analysis was performed to evaluate correlations with CRP levels.Multivariate logistic regression was used to identify independent factors associated with postoperative infection.Receiver operating characteristic(ROC)curves were used to assess predictive performance.An additional prospective cohort of 50 patients(March-October 2024)was used for validation. Results:The proportions of diabetes,gallstones,and high-level obstruction were significantly higher in the infection group(all P<0.05).On postoperative day 1,levels of CRP,TLR2 mRNA,HDC,and CD64 were significantly higher in the infection group than in the non-infection group(all P<0.05).TLR2 mRNA,HDC,and CD64 levels were positively correlated with CRP(r=0.729,0.682,and 0.755,respectively;all P<0.05)and infection severity.After adjusting for diabetes,gallstones,and obstruction level,TLR2 mRNA,HDC,and CD64 remained independent factors associated with postoperative biliary infection(all P<0.05).ROC analysis showed that the combined detection of TLR2 mRNA,HDC,and CD64 achieved an AUC of 0.923,with a sensitivity of 89.13%and specificity of 84.10%.Prospective validation demonstrated good agreement between predicted and actual outcomes(κ=0.864). Conclusion:Elevated levels of TLR2 mRNA,HDC,and CD64 are associated with postoperative biliary infection in patients with malignant biliary obstruction.Combined detection of these biomarkers may serve as a promising strategy for early prediction of postoperative biliary infection.关键词
胆道疾病/胆汁淤积/支架/手术后并发症/胆道感染Key words
Biliary Tract Diseases/Cholestasis/Stents/Postoperative Complications/Biliary Infection分类
医药卫生引用本文复制引用
孟令雷,李少腾,王晓娟,李德茂,高凤霄..恶性胆道梗阻介入术后胆道感染患者TLR2 mRNA、HDC和CD64表达特征及预测价值[J].中国普通外科杂志,2026,35(2):269-278,10.基金项目
河北省邢台市重点研发计划自筹基金资助项目(2020ZC370). （2020ZC370）
