外周血TGF-β1/Smads信号通路蛋白对乳腺癌改良根治术后感染的预测价值及影响因素

doi:10.3969/j.issn.1006-5725.2026.18.005

Abstract

Abstract:

Objective To explore the predictive value and influencing factors of peripheral blood transforming growth factor β1 （TGF-β1）/Smad protein family （Smads） signaling pathway proteins on infection after modified radical mastectomy for breast cancer. Methods From January 2023 to June 2025， the clinical data of 419 patients with breast cancer in the hospital were retrospectively selected as the research object， all of them were treated by modified radical mastectomy， and they were divided into the infection group （62 cases） and the non-infection group （357 cases） according to their postoperative infection. The general data and the levels of TGF-β1/Smads signaling pathway related proteins were compared between the two groups， and the influencing factors of infection after modified radical mastectomy and the predictive value of TGF-β1/Smads signaling pathway protein for infection after modified radical mastectomy were analyzed. Results The proportion of patients with diabetes mellitus and the levels of TGF-β1， Smad2 and Smad3 protein in peripheral blood mononuclear cells in the infected group were higher than those in the non-infected group， and the postoperative intubation time was longer than that in non-infected group （P < 0.05）. Complication of diabetes mellitus， long postoperative intubation time and high levels of TGF-β1， Smad2 and Smad3 protein in peripheral blood mononuclear cells are all influencing factors of infection after modified radical mastectomy （OR = 3.751， 1.244， 1.422， 1.411， 1.449， P < 0.05）. The area under infection curve （AUC） value of TGF-β1， Smad2 and Smad3 combined in predicting patients after modified radical mastectomy was higher than that of the three alone （P < 0.05）， and their sensitivity and specificity were 72.58% and 89.64% respectively. Conclusions The influencing factors of infection after modified radical mastectomy for breast cancer included diabetes mellitus， long postoperative catheterization time and higher levels of TGF-β1， Smad2 and Smad3 protein in peripheral blood mononuclear cells. At the same time， the combined detection of TGF-β1， Smad2 and Smad3 protein in peripheral blood mononuclear cells to evaluate the infection of patients after modified radical mastectomy for breast cancer could maintain a high sensitivity （72.58%） and significantly improve the specificity （89.64%）.

Key words: modified radical mastectomy, infection, influencing factors, transforming growth factor β1, smad protein family, signal channel

CLC Number:

R737.9

Min Hua, Fan Ouyang, Xueying Zhu, Liling Zhao, Rui Zhang. The predictive value and influencing factors of TGF-β1/Smads signaling pathway proteins in peripheral blood for infection after modified radical mastectomy for breast cancer[J]. The Journal of Practical Medicine, 2026, 42(18): 3270-3277.

Figures/Tables 6

Fig.1

Tab.1

Tab.2

Tab.3

Tab.4

Fig.2

References 26

[1]	Alam B， Akbari A R， Alali B， et al. Antibiotic prophylaxis in breast surgery： A meta-analysis to identify the optimal strategy to reduce infection rates in breast surgery［J］. Breast Cancer， 2022， 29（6）： 945-956. doi：10.1007/s12282-022-01387-5 .
[2]	Mohite P P， Kanase S B. Effectiveness of Scapular Strengthening Exercises on Shoulder Dysfunction for Pain and Functional Disability after Modified Radical Mastectomy： A Controlled Clinical Trial［J］. Asian Pac J Cancer Prev， 2023， 24（6）： 2099-2104. doi：10.31557/APJCP.2023.24.6.2099 .
[3]	Michalopoulos N V， Frountzas M， Karathanasis P， et al. Implant infections after breast reconstruction surgery following mastectomy： Experience from a Greek breast unit［J］. Breast Dis， 2022， 41（1）： 37-44. doi：10.3233/BD-201077 .
[4]	Akazawa N， Itoh N， Ishibana Y， et al. Successful management of surgical site infection caused by Mycobacterium mageritense in a breast cancer patient［J］. J Infect Chemother， 2024， 30（8）： 800-805. doi：10.1016/j.jiac.2024.01.014 .
[5]	Zheng Bingfeng， Li Chunshan， Wang Shaoyuan. Skin incisional wound infection caused by Streptococcus dysgalactiae subspecies equisimilis （SDSE） after breast cancer surgery： A case report［J］. Asian J Surg， 2023， 46（12）： 5730-5731. doi：10.1016/j.asjsur.2023.08.103 .
[6]	Morgan R C， Frank C， Greger M， et al. TGF-β promotes the postselection thymic development and peripheral function of IFN-γ-producing invariant NKT cells［J］. J Immunol， 2023， 211（9）： 1376-1384. doi：10.4049/jimmunol.2200809 . ［PubMed］
[7]	Lai L Y S， Gracie N P， Gowripalan A， et al. SMAD proteins： Mediators of diverse outcomes during infection［J］. Eur J Cell Biol， 2022， 101（2）： 151204-151204. doi： 10.1016/j.ejcb.2022. 151204 .
[8]	Chandiran K， Cauley L S. The diverse effects of transforming growth factor-β and SMAD signaling pathways during the CTL response［J］. Front Immunol， 2023， 14： 1199671. doi：10.3389/fimmu.2023.1199671 .
[9]	中国抗癌协会乳腺癌专业委员会，中华医学会肿瘤学分会乳腺肿瘤学组，邵志敏. 中国抗癌协会乳腺癌诊治指南与规范（2024年版）［J］. 中国癌症杂志， 2023， 33（12）： 1092-1186. doi：10.19401/j.cnki.1007-3639.2023.12.004 .
[10]	姜纪华，刘翠萍. 医院感染管理［M］. 北京：北京大学医学出版社， 2010： 78-81.
[11]	孙正霞，张林，常家琦，等. 胸横肌平面-胸神经阻滞辅助下羟考酮-丙泊酚少阿片全身麻醉在乳腺癌保乳手术中的有效性及安全性［J］. 实用医学杂志， 2026， 42（5）： 734-741. doi：10.3969/j.issn.1006-5725.2026.05.002 .
[12]	Zhang Chao， Li Juanjuan， Wang Lin， et al. The effect of neoadjuvant chemotherapy on surgical site wound infection after immediate breast reconstruction in patients with breast cancer： A meta-analysis［J］. Int Wound J， 2024， 21（1）： e14337. doi：10.1111/iwj.14337 .
[13]	Olsen M A， Nickel K B， Margenthaler J A， et al. Nipple-sparing mastectomy and infection risk after immediate breast reconstruction［J］. J Am Coll Surg， 2025， 241（2）： 254-260. doi：10.1097/XCS.0000000000001424 .
[14]	钟燕澜，张卿，彭云. 乳腺癌术后化疗病人感染风险预测模型的构建［J］. 护理研究， 2025，39（23）：3934-3941. doi.10.12102/j.issn.1009⁃6493.2025，23，005.
[15]	Liu Yufei， Qi Yao， Chen Chen， et al. Platelet-mimetic nano-sensor for combating postoperative recurrence and wound infection of triple-negative breast cancer［J］. J Control Release， 2023， 362： 396-408. doi：10.1016/j.jconrel.2023.08.057 .
[16]	Lukan N， Hajdukova A， Kolarcik P， et al. How can an immunologist influence the occurrence of secondary infections in breast cancer？ Real-life study［J］. Bratisl Lek Listy， 2023， 124（5）： 363-367. doi：10.4149/BLL_2023_055 .
[17]	钱芳，孙永强，张思涵，等. 乳腺癌改良根治术后感染的病原学特征、影响因素及炎症因子分析［J］. 中国癌症杂志， 2025， 35（6）： 563-569. doi：10.19401/j.cnki.1007-3639.2025.06.005 .
[18]	Pramanik R， Chattopadhyay S， Bishayi B. Dual neutralization of TGF-β and IL-21 regulates Th17/Treg balance by suppressing inflammatory signalling in the splenic lymphocytes of Staphylococcus aureus infection-induced septic arthritic mice［J］. Immunol Res， 2025， 73（1）： 38. doi：10.1007/s12026-024-09586-2 .
[19]	Roberson D S， Mcleay M T， Henning G， et al. The impact of prophylactic incisional negative pressure wound therapy on surgical site infection following open radical cystectomy［J］. Urologic Oncol Semin Orig Investig， 2025， 43（10）： 586-593. doi：10.1016/j.urolonc.2025.07.010 .
[20]	Jørgensen M G， Gözeri E， Petersen T G， et al. Surgical-site infection is associated with increased risk of breast cancer-related lymphedema： A nationwide cohort study［J］. Clin Breast Cancer， 2023， 23（5）： e296-e304.e2. doi：10.1016/j.clbc.2023.03.016 .
[21]	Yuri A， Nakane S， Miyano Y， et al. Risk of severe infections in patients with triple-negative breast cancer treated with atezolizumab plus nab-paclitaxel： A real-world， postmarketing database study in Japan［J］. Int J Clin Oncol， 2025， 30（12）： 2541-2548. doi： 10.1007/s10147-025-02904-0 .
[22]	Zhao Jie， Yang Yang， Chen Xi， et al. Upper respiratory tract infection associated with anti-HER2 antibody blockade for HER2-positive breast cancer： A Bayesian disproportionality analysis using data from the FDA adverse event reporting system［J］. Clin Ther， 2025， 47（12）： 1155-1160. doi：10.1016/j.clinthera. 2025.09.015 .
[23]	Geng Kang， Ma Xiumei， Jiang Zongzhe， et al. WDR74 facilitates TGF-β/Smad pathway activation to promote M2 macrophage polarization and diabetic foot ulcer wound healing in mice［J］. Cell Biol Toxicol， 2023， 39（4）： 1577-1591. doi：10.1007/s10565-022-09748-8 .
[24]	Wang Yuanying， Sun Di， Dilixiati N， et al. Nerandomilast， a PDE4B inhibitor， alleviates silica-induced lung inflammation and fibrosis by inhibition of NLRP3 inflammasome and TGF-β/Smad signalling［J］. Br J Pharmacol， 2026， 183（7）： 1445-1464. doi：10.1111/bph.70240 .
[25]	Miao Youhan， Wang Meihua， Cai Xiaojuan， et al. Leucine rich alpha-2-glycoprotein 1 （Lrg1） silencing protects against sepsis-mediated brain injury by inhibiting transforming growth factor beta1 （TGFβ1）/SMAD signaling pathway［J］. Bioengineered， 2022， 13（3）： 7316-7327. doi：10.1080/21655979.2022. 2048775 .
[26]	Liu Huidong， Zhang Xiao， Zhang Mengtong， et al. Mesenchymal stem cell derived exosomes repair uterine injury by targeting transforming growth factor-β signaling［J］. ACS Nano， 2024， 18（4）： 3509-3519. doi：10.1021/acsnano.3c10884 .

因素	感染组（n = 62）	非感染组（n = 357）	t/χ²/Z值	P值
年龄/岁	56.48 ± 5.38	55.82 ± 5.19	0.919	0.358
体质量指数/（kg/m²）	21.02 ± 0.84	20.88 ± 0.81	1.249	0.212
糖尿病/［例（%）］
有	9（14.52）	21（5.88）	4.696^*	0.030
无	53（85.48）	336（94.12）
高血压/［例（%）］
有	10（16.13）	32（8.96）	3.007	0.083
无	52（83.87）	325（91.04）
高脂血症/［例（%）］
有	8（12.90）	25（7.00）	2.535	0.111
无	54（87.10）	332（93.00）
美国麻醉医师协会分级/［例（%）］
Ⅰ级	14（22.58）	83（23.25）	1.097	0.273
Ⅱ级	39（62.90）	183（51.26）
Ⅲ级及以上	9（14.52）	91（25.49）
手术时间/h	1.93 ± 0.54	1.86 ± 0.49	1.022	0.307
术中失血量/mL	368.74 ± 69.40	363.71 ± 66.88	0.544	0.587
脂肪液化/［例（%）］
有	4（6.45）	12（3.36）	0.661^*	0.416
无	58（93.55）	345（96.64）
预防性使用抗菌药物/［例（%）］
有	21（33.87）	156（43.70）	2.091	0.148
无	41（66.13）	201（56.30）
置管时间/d	10.98 ± 3.26	8.91 ± 2.51	5.714	< 0.001
术后引流量/mL	775.48 ± 83.28	769.50 ± 80.77	0.536	0.592
TGF-β1/Smad信号通路蛋白
TGF-β1	13.73 ± 4.21	9.05 ± 3.62	9.163	< 0.001
Smad2	30.84 ± 6.40	25.33 ± 5.51	7.089	< 0.001
Smad3	43.84 ± 7.88	35.37 ± 6.82	8.813	< 0.001

变量	赋值
术后感染	是 = 1，否 = 0
糖尿病	有 = 1，无 = 0
TGF-β1蛋白水平	原值输入
Smad2蛋白水平	原值输入
Smad3蛋白水平	原值输入
术后置管时间	原值输入

影响因素	β	SE	Wald χ²	P值	OR值	95%CI
合并糖尿病	1.322	0.426	9.630	0.002	3.751	1.627 ~ 8.645
术后置管时间较长	0.218	0.102	4.568	0.033	1.244	1.018 ~ 1.519
TGF-β1蛋白水平较高	0.352	0.113	9.704	0.002	1.422	1.139 ~ 1.774
Smad2蛋白水平较高	0.344	0.125	7.574	0.006	1.411	1.104 ~ 1.802
Smad3蛋白水平较高	0.371	0.137	7.333	0.007	1.449	1.108 ~ 1.896

指标	截断值	AUC	95%CI	敏感度/%	特异度/%	约登指数	Z值	P值
TGF-β1	11.88	0.808	0.767 ~ 0.845	70.97	78.99	0.500	9.655	< 0.001
Smad2	26.44	0.772	0.728 ~ 0.811	80.65	62.18	0.428	8.701	< 0.001
Smad3	40.89	0.791	0.748 ~ 0.829	69.35	75.91	0.453	8.987	< 0.001
联合	-	0.874	0.838 ~ 0.904	72.58	89.64	0.622	14.992	< 0.001

The predictive value and influencing factors of TGF-β1/Smads signaling pathway proteins in peripheral blood for infection after modified radical mastectomy for breast cancer

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 26

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Hongyu WU,Yupeng WU,Shaojuan HUANG,Suzhen HUANG,Yingjie HOU,Yi YANG,Zhirong ZHANG,Qingxi LI,Zhixin WU. Risk prediction of postoperative cerebral infarction in elderly patients with intertrochanteric femoral fracture： A comparative study of decision tree and logistic regression model [J]. The Journal of Practical Medicine, 2026, 42(8): 1471-1478.
[2]	Hongzhi LI,Xian GAO,Fei SHEN,Jing LI,Jinsheng WEI. Risk factors for latent tuberculosis infection and the application value of AIMTB testing in screening： A prospective study design based on close contact populations [J]. The Journal of Practical Medicine, 2026, 42(7): 1142-1148.
[3]	Junmei ZHU,Yinting ZHU,Liting ZHOU,Ruru BI. Development and validation of a predictive model for carbapenem-resistant Enterobacteriaceae bloodstream infections based on DynNom dynamic scoring [J]. The Journal of Practical Medicine, 2026, 42(6): 1063-1069.
[4]	Wei GONG,Tianle GAO,Jin WANG. Analysis of influencing factors for secondary fractures in adjacent vertebrae after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures based on sagittal parameters of the spine-pelvis， fracture characteristics， and treatment-related clinical features [J]. The Journal of Practical Medicine, 2026, 42(6): 1088-1096.
[5]	Pengzheng LI,Baoguo CHENG,Jinzhan LIU,Weixing LI. Application of CT perfusion parameters and serum CEA/AFP in monitoring post-TACE recurrence in primary hepatocellular carcinoma [J]. The Journal of Practical Medicine, 2026, 42(2): 176-184.
[6]	Fengren LIU,Pengcheng LI,Wen ZHANG,Feng LI. The application of serum IL⁃7， LDH/ALB and sCD14⁃ST in the diagnosis and disease assessment of COPD combined with PI [J]. The Journal of Practical Medicine, 2026, 42(2): 236-248.
[7]	Huimin Zheng, Fengqing Song, Mengchun Wu, Xiaoxing Tan, tao Yu, Jing Du. Heterogeneity analysis of cryptogenic and non-cryptogenic liver abscesses and the clinical value of mNGS in pathogen diagnosis [J]. The Journal of Practical Medicine, 2026, 42(17): 3150-3157.
[8]	Kun Shi, Yang Wang, Xiuxia Zhang, Xuhan Zhang, Xiaoyan Chen, Lanlan Chen, Manyu Zou, Lili Wu. Latent class trajectory model analysis on catch-up growth patterns of moderate-late preterm infants at corrected age of 0 ⁃ 18 months [J]. The Journal of Practical Medicine, 2026, 42(17): 3215-3221.
[9]	Sijia Chen, Hui Li, Xiaoyu Li. The pathogenic bacteria distribution of pulmonary infection in elderly patients with chronic kidney disease during maintenance hemodialysis and the appraised value of serum NGAL， sP-selectin and MCP-1 [J]. The Journal of Practical Medicine, 2026, 42(16): 2972-2980.
[10]	Jing YIN,Qinghua WU,Hongyan QIAO. The value of ankle brachial index， vascular endothelial growth factor and infection indicators in predicting the prognosis of interventional therapy with arteriosclerosis obliterans complicated with ischemic gangrene infection [J]. The Journal of Practical Medicine, 2026, 42(13): 2419-2427.
[11]	Tao LÜ,Ran TAO,Min ZHANG,Changmin LÜ,Qingrong MENG,Shiping WANG. The relationship between iNOS， CER and NLRP3/IL-1β signal pathway and urinary tract infection after bladder cancer operation [J]. The Journal of Practical Medicine, 2026, 42(11): 2056-2063.
[12]	Aoshuang QIN,Chen YANG,Xin CUI,Gejia MA,Xiaowei GUO,Xuchuan ZHOU,Bin LIU. Hyaluronic acid scaffold combined with adipose⁃derived stem cells [J]. The Journal of Practical Medicine, 2025, 41(7): 991-996.
[13]	Xinguo WU,Ruhua ZHENG,Xin CHANG,Chunyan NIU,Fuyu. ZHANG. Interpretation of ACG clinical practice guideline in 2024： treatment of helicobacter pylori infection [J]. The Journal of Practical Medicine, 2025, 41(4): 459-464.
[14]	Yufeng LUO,Biao LIANG,Xiaodong CHEN,Xiaoqiao YANG,Ling. HE. Correlation between intestinal flora imbalance and colorectal polyps and intestinal metaplasia of Hp infection [J]. The Journal of Practical Medicine, 2025, 41(21): 3352-3357.
[15]	Ruiyi JIA,Bo ZHANG,Guoyun YU,Jiawei QIANG,Xinyu WANG,Guifen. PANG. The impact of chronic obstructive pulmonary disease combined with hypertension on cardiovascular events [J]. The Journal of Practical Medicine, 2025, 41(21): 3358-3364.