摘要
目的比较严重多发伤患者外周血辅助性T淋巴细胞(Th)1/Th2因子水平变化及其对医院感染的预测价值。方法选取安徽医科大学附属宿州医院2018年8月—2021年4月收治的135例严重多发伤患者为疾病组,另于同时间段招募128名健康志愿者作为对照组,采用酶联免疫吸附法测定Th1细胞因子:白细胞介素(IL)-2、γ干扰素(IFN-γ);Th2细胞因子:IL-4、IL-10。疾病组在入院48 h后检测外周血Th1/Th2细胞因子水平,按照有无发生医院感染分为感染组和未感染组,分析感染及病原体分布情况,及其Th1/Th2细胞因子水平变化;分析疾病组不同部位创伤患者外周血Th1、Th2细胞因子水平;绘制ROC曲线,采用曲线下面积(AUC)评价入院48 h后外周血各项Th1/Th2细胞因子及联合预测疾病组医院感染的价值。结果疾病组IL-2、IFN-γ水平均低于对照组(P<0.05),而IL-4和IL-10水平均高于对照组(P<0.05)。疾病组不同部位创伤患者Th1、Th2细胞因子水平差异无统计学意义(P>0.05);疾病组医院感染发生率为34.1%,不同感染类型患者革兰阴性菌占比均较高;感染组IL-2、IFN-γ水平均低于未感染组(P<0.05),IL-4和IL-10水平均高于未感染组(P<0.05);不同创伤部位患者医院感染发生率比较差异无统计学意义(P>0.05),且不同创伤部位医院感染患者IL-2、INF-γ水平均低于未感染患者(P<0.05),IL-4和IL-10水平均高于未感染患者(P<0.05);IL-2、IFN-γ、IL-4、IL-10联合预测疾病组医院感染的特异度高于各个指标单独预测(P<0.01),AUC高于单独预测(P<0.05),灵敏度与单独预测差异无统计学意义(P>0.05)。结论严重多发伤患者IL-2、IFN-γ水平下降,IL-4、IL-10水平升高,Th1向Th2漂移,发生医院感染的患者上述趋势更明显,此类患者常见革兰阴性菌感染,且各细胞因子水平联合对医院感染的预测价值高。
Objective To investigate the changes and predictive value of peripheral blood helper T lymphocyte 1(Th1)/helper T lymphocyte 2(Th2)cytokines for nosocomial infection in patients with severe multiple trauma.Methods A total of 135 patients with severe multiple trauma treated in Suzhou Hospital from August 2018 to April 2021 were selected as case group.Another 128 contemporary healthy volunteers were recruited as the control group.Enzyme linked immunosorbent assay(ELISA)was used to analyze Th1/Th2 cytokine levels,including Th1 type cytokines such as interleukin-2(IL-2)and interferon-γ(IFN-γ)and Th2 type cytokines such as IL-4 and IL-10.In addition,the Th1/Th2 cytokine levels were determined 48 hours after admission for the case group.The distribution of nosocomial infections and pathogens were described.Th1/Th2 levels were compared between the patients with nosocomial infection and those without nosocomial infection.Th1/Th2 cytokine levels were compared in terms of different body sites in patients with trauma.The receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was used to evaluate the value of various peripheral blood Th1/Th2 cytokines 48 hours after admission alone and combined in predicting the risk of nosocomial infection in case group.Results The case group demonstrated significantly lower IL-2 and IFN-γ levels,but significantly higher IL-4 and IL-10 levels than control group(P<0.05).Th1/Th2 cytokine levels did not vary significantly with different body sites of trauma in patients with trauma(P>0.05).The incidence of nosocomial infection was 34.1%in the case group.Gram-negative bacteria accounted for higher percentage in different types of infection.The IL-2 and IFN-γ levels in the infection group were significantly higher than those in the control group(P<0.05).The IL-4 and IL-10 levels in the infection group were higher than those in the non-infection group(P<0.05).The incidence of nosocomial infection did not show significant difference between the patients with di
作者
张慧秋
刘丽
刘玲
沙梦龙
鲁海艳
ZHANG Huiqiu;LIU Li;LIU Ling;SHA Menglong;LU Haiyan(Department of Critical Care Medicine,Suzhou Hospital Affiliated to Anhui Medical University,Suzhou Anhui 234000,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2022年第4期418-424,共7页
Chinese Journal of Infection and Chemotherapy
基金
2020年江苏省重点研发计划(社会发展)专项资金项目(BE2020786)。
