摘要
目的:分析SAP并发感染的危险因素及其对炎症因子和T淋巴细胞亚群的影响。方法:选取2018年2月至2019年4月间四川德阳市人民医院收治的150例SAP患者,按是否并发感染分为感染组(90例)和未感染组(60例),分析感染灶的病原菌属、并发感染的危险因素、血炎症因子水平和T淋巴细胞亚群的变化。结果:90例SAP并发感染患者共检出105株病原菌,其中74株(70.5%)革兰阴性菌,主要以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌为主;27株(25.7%)革兰阳性菌,主要为金黄色葡萄球菌;4株(3.8%)真菌。胆源性病因、全肠外营养时间≥1周、APACHEⅡ评分≥11分、外科干预以及呼吸道机械通气均是SAP并发感染的独立危险因素(P值均<0.05)。发病24 h,感染组患者血IL-4为(59.1±6.2)ng/L、IL-6为(134.1±12.2)ng/L、IL-10为(146.4±13.2)ng/L、TNF-ɑ为(76.3±5.2)ng/L,均显著高于未感染组;发病30 d,感染组患者血IL-4为(33.6±5.8)ng/L、IL-6为(49.2±6.8)ng/L、IL-10为(80.7±8.8)ng/L、TNF-ɑ为(28.7±5.5)ng/L,均显著低于未感染组,差异均有统计学意义(P值均<0.05)。发病24 h,感染组CD 4+T淋巴细胞占比显著高于未感染组[(45.3±5.5)%比(32.3±5.2)%],CD 8+T淋巴细胞占比显著低于未感染组[(20.6±4.2)%比(29.7±4.8)%];发病30 d,感染组CD 4+T淋巴细胞占比显著低于未感染组[(21.6±3.7)%比(40.2±2.5)%],CD 8+T淋巴细胞占比显著高于未感染组[(48.4±4.1)%比(32.8±4.0)%],差异均有统计学意义(P值均<0.05)。结论:SAP并发感染的菌株以革兰阴性菌为主,胆源性病因、全肠外营养时间过长、外科干预、呼吸机械通气均是SAP并发感染的危险因素。SAP感染可产生过度炎症反应,导致患者免疫细胞损伤,在临床治疗时应予重视。
Objective To analyze the risk factors for severe acute pancreatitis(SAP)complicated with infection and the effects on immune level.Methods A total of 150 SAP patients admitted to Deyang People′s Hospital from February 2018 to April 2019 were divided into the infected group(n=90)and the uninfected group(n=60)according to whether SAP was complicated with infection or not;the changes of pathogenic bacteria in the infection focus,infection risk factors,blood inflammatory cytokines levels and T-lymphocyte subgroups were analyzed.Results A total of 105 pathogenic bacteria were detected in 90 SAP patients with infection,among which 74(70.5%)were gram-negative bacteria,mainly escherichia coli,klebsiella pneumoniae and pseudomonas aeruginosa.There were 27 strains(25.7%)of gram-positive bacteria,mainly staphylococcus aureus,and 4 strains(3.81%)of fungi.Biliary causes,total parenteral nutrition time≥1 week,APACHEⅡscore≥11,surgical intervention,and respiratory mechanical ventilation were all independent factors for SAP infection(all P<0.05).At 24 hours after onset,blood IL-4(59.1±6.2)ng/L,IL-6(134.1±12.2)ng/L,IL-10(146.4±13.2)ng/L,TNF-ɑ(76.3±5.2)ng/L in infected group were all significantly higher than those in the uninfected group(all P values<0.05);at 30 days after the onset,blood IL-4(33.6±5.8)ng/L,IL-6(49.2±6.8)ng/L of the infected group,IL-10(80.7±8.8)ng/L,TNF-ɑ(28.7±5.5)ng/L in infected group were significantly lower than those in the uninfected group(all P values<0.05).At 24 hours after onset,the proportion of CD4+T lymphocytes in the infected group was significantly higher than that in the uninfected group[(45.3±5.5)%vs(32.3±5.2)%],and the proportion of CD8+T lymphocytes was significantly lower than that in the uninfected group[(20.6±4.2)%vs(29.7±4.8)%];at 30 days after onset,the proportion of CD4+T lymphocytes in the infected group was significantly lower than that in the uninfected group[(21.6±3.7)%vs(40.2±2.5)%],and the proportion of CD8+T lymphocytes was significantly higher in the uninfected group[(48.4±4.1)%vs(32.8±4.0)%];and all the differences were statistically significant(all P<0.05).Conclusions The strains of concurrent infection with SAP were mainly gram-negative bacteria.Biliary causes,total parenteral nutrition time,surgical intervention and respiratory mechanical ventilation were all risk factors for concurrent infection with SAP.SAP infection may cause excessive inflammatory response and lead to immune cell damage,which should be paid attention to in clinical treatment.
作者
谢蕾
刘航
申洋
李金枝
赵天霞
Xie Lei;Liu Hang;Shen Yang;Li Jinzhi;Zhao Tianxia(Department of Nuclear Medicine,People′s Hospital of Deyang City,Deyang 618000,China;Center of Acute Pancreatitis,People′s Hospital of Deyang City,Deyang 618000,China;Department of Gastroenterology,People′s Hospital of Deyang City,Deyang 618000,China;Department of Pneumology,People′s Hospital of Deyang City,Deyang 618000,China)
出处
《中华胰腺病杂志》
CAS
2020年第4期283-287,共5页
Chinese Journal of Pancreatology
关键词
胰腺炎
急性坏死性
感染
T淋巴细胞亚群
病原菌
炎症因子
Pancreatitis,acute necrotizing
Infection
Tlymphocyte subsets
Pathogenic bacteria
Inflammatory cytokines
