摘要
目的探讨重症肺炎患者病原菌分布及Th1/Th2/Th17相关细胞因子在病原学诊断中的临床价值.方法选取2018年6月—2019年7月于徐州医科大学附属医院治疗的重症肺炎患者,入院当天抗生素应用前利用流式荧光法检测血清Th1/Th2/Th17相关细胞因子水平,例如肿瘤坏死因子(TNF-α)、干扰素(INF-γ)、IL-2、IL-4、IL-6、IL-10、IL-17A,分析其预测感染和病原学种类的诊断价值,同时应用全自动微生物分析仪进行病原菌培养与鉴定.同期健康体检者81人作为对照组.结果入组检出病原菌的患者剔除混合菌属感染106例,根据病原学结果分为三组:革兰阴性菌(G-)组38例,革兰阳性菌(G+)组36例,非细菌感染组32例(病毒17例,真菌15例);细菌培养分离出合格菌株146株,革兰阴性菌60株,占41.09%,革兰阳性菌52株,占36.98%,其中金黄色葡萄球菌43株,占29.44%.与对照组比较,G+菌组和G-菌组、非细菌感染组细胞因子IL-2、IL-4、IL-6、IL-17A、IL-10、IFN-γ水平均有不同程度的增高且差异有统计学意义(均P<0.05).G-菌组、G+菌组的IL-6水平高于非细菌感染组(均P<0.05),且G-菌组IL-6和IL-2水平均高于G+菌组(P<0.05);非细菌组的IL-2水平高于G+菌组(P<0.05);G+菌组的IL-10水平高于G-菌组与非细菌感染组(均P<0.05).结论Th1/Th2相关细胞因子对重症肺炎患者感染和病原学诊断具有良好的指导价值,但在临床工作中,还应结合患者实际情况,进行综合考虑.重症肺炎患者感染金黄色葡萄球菌占29.44%,需在治疗中给予重视.
Objective To investigate the distribution of pathogenic bacteria in patients with severe pneumonia and the clinical value of Th1/Th2/Th17 related cytokines in the diagnosis of pathogens.Methods We selected patients with severe pneumonia who were admitted to the Affiliated Hospital of Xuzhou Medical University from June 2018 to July 2019.Before the application of antibiotics on the day of admission,the levels of Th1/Th2/Th17 related cytokines(including TNF-α,interferon(INF-γ),IL-2,IL-4,IL-6,IL-10,IL-17A)were measured by flow cytometry,to analyze the diagnostic value of its predictive infection and etiological species.Meanwhile,the pathogen was cultured and identified by automatic microbiological analyzer.81 healthy people in the same period were taken as the control group.Results 106 patients with mixed bacterial infection were divided into three groups according to the etiological results:Gram-negative bacteria(G-)group(38 cases),Gram-positive bacteria(G+)group(36 cases)and non-bacterial infection group(32 cases)(virus 17 cases and fungi 15 cases).146 qualified strains were isolated from clinical specimens of patients,including 60 G-(41.09%),52 G+(36.98%),and 43 Staphylococcus aureus(29.44%).Compared with the control group,the levels of cytokines IL-2,IL-4,IL-6,IL-17A,IL-10,IFN-γ in G+group,G-group and non-bacterial infection group were increased in varying degrees and the difference was statistically significant(all P<0.05).The level of IL-6 in G-group and G+group was higher than that in non-bacterial infection group(both P<0.05),and the levels of IL-6 and IL-2 in G-group were higher than those in G+group(P<0.05).The level of IL-2 in non-bacterial infection group was higher than that in G+group.The level of IL-10 in G+group was higher than that in G-group and non-bacterial infection group(both P<0.05).Conclusion:Th1/Th2 related cytokines have a good guiding value for etiological diagnosis of patients with severe pneumonia,but in the real clinical work,we still need to consider comprehensively from the actual
作者
方堃
卓越
徐荣良
李丽
许铁
叶英
FANG Kun;ZHUO Yue;XU Rongliang;LI Li;XU Tie;YE Ying(Emergency department of Affiliated Hospital of Xuzhou Medical University,XuZhou Jiangsu 221000,China)
出处
《中国急救复苏与灾害医学杂志》
2021年第5期501-504,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
国家青年科学基金项目(编号:31800810)。
