开放性骨折患者手术部位感染对机体免疫功能及细胞因子的影响
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摘要
目的探讨开放性骨折患者手术部位感染对机体免疫功能及细胞因子的影响。方法研究对象选取武警北京总队医院2015年6月至2017年6月间收治的开放性骨折患者120例,以开放性骨折患者手术后感染患者44例为观察组,未感染患者76例为对照组。采用酶联免疫吸附测定法检测两组T淋巴细胞亚群及NK细胞水平、白细胞介素-4(IL?4)、白细胞介素-6(IL?6)、白细胞介素-10(IL?10)、抗血管内皮生长因子(VEGF)、基质细胞衍生因子1(SDF1)及肿瘤坏死因子α(TNF?α)蛋白水平,同时对观察组取创面分泌物行细菌培养。结果 44例开放性骨折术后感染患者共分离44株病原菌,其中金黄色葡萄球菌占52.27%,肺炎克雷伯菌占31.81%,大肠埃希菌占11.36%;观察组的T淋巴细胞亚群及NK细胞水平均显著低于对照组,两组差异有统计学意义(P<0.05);观察组的IL?4、IL?6、IL?10、VEGF、SDF1及TNF?α蛋白水平均显著高于对照组,两组差异有统计学意义(P<0.05)。结论开放性骨折患者术后感染可引起患者免疫功能的降低,此外血清白细胞介素因子及VEGF、SDF1及TNF?α水平可作为诊断及判断预后指标。
Objective To investigate the effect of surgical site infection on immune function and cytokines expression in patients with open fracture. Methods 120 patients with open fracture were selected from June 2015 to June 2017 in the General Hospital of the Chinese People.s Armed Police Force. The patients with open fracture were treated as observation group(44 cases)and uninfected group as control group(76 cases). The level of T-lymphocyte subsets and NK cell,interleukin-4(IL-4),interleukin-6(IL-6),interleukin-10(IL-10)and vascular endothelial growth factor(VEGF),stromal cell-derived factor-1(SDF1),and tumor necrosis factor-α(TNF-α)were measure by enzyme linked immunosorbent. And the bacteria were cultured from the wound secretion in the observation group. Results A total of 44 strains of pathogenic bacteria were isolated from 44 patients with open fracture infection;Staphylococcus aureus accounted for 52.27%,Klebsiella pneumoniae 31.81% and Escherichia coli 11.36%. The levels of T lymphocyte subsets and NK cells in the observation group were significantly lower than those in the control group(P<0.05). The levels of IL-4,IL-6,IL-10,VEGF,SDF1 and TNF-αprotein in the observation group were significantly higher than those in the control group,and the difference between the two groups was statistically significant(P<0.05). Conclusion Infection in open fracture patients could impair the immune function in patients. In addition,serum interleukin cytokines and levels of VEGF,SDF1 and TNF-α could be used as a diagnostic and prognostic indicator.
Objective To investigate the effect of surgical site infection on immune function and cytokines expression in patients with open fracture. Methods 120 patients with open fracture were selected from June 2015 to June 2017 in the General Hospital of the Chinese People.s Armed Police Force. The patients with open fracture were treated as observation group(44 cases)and uninfected group as control group(76 cases). The level of T-lymphocyte subsets and NK cell,interleukin-4(IL-4),interleukin-6(IL-6),interleukin-10(IL-10)and vascular endothelial growth factor(VEGF),stromal cell-derived factor-1(SDF1),and tumor necrosis factor-α(TNF-α)were measure by enzyme linked immunosorbent. And the bacteria were cultured from the wound secretion in the observation group. Results A total of 44 strains of pathogenic bacteria were isolated from 44 patients with open fracture infection;Staphylococcus aureus accounted for 52.27%,Klebsiella pneumoniae 31.81% and Escherichia coli 11.36%. The levels of T lymphocyte subsets and NK cells in the observation group were significantly lower than those in the control group(P<0.05). The levels of IL-4,IL-6,IL-10,VEGF,SDF1 and TNF-αprotein in the observation group were significantly higher than those in the control group,and the difference between the two groups was statistically significant(P<0.05). Conclusion Infection in open fracture patients could impair the immune function in patients. In addition,serum interleukin cytokines and levels of VEGF,SDF1 and TNF-α could be used as a diagnostic and prognostic indicator.
引文
[1]虞伟琴,谢垒,钱小毛.开放性骨折患者手术部位感染的危险因素分析[J].中国骨与关节损伤杂志,2017,32(5):550-551.
[2]王宇强,贾永森,苏学涛,等.开放性骨折患者术后感染病原菌分布及对血清MMPs,SDF-1,VEGF和TNF-α表达影响研究[J].临床和实验医学杂志,2016,15(22):2223-2226.
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[4]李筱轶,秦瑾,张虎波,等.开放性骨折术后伤口感染的危险因素分析[J].中华老年骨科与康复电子杂志,2017,3(2):85-90.
[5]王韬,晏新,扶世杰,等.开放性骨折患者医院感染临床分析及预防措施[J].中华医院感染学杂志,2015,25(10):2291-2293.
[6]赖晓虹,陈丽丹,黄晓燕,等.1 261例骨科感染患者病原菌分布及耐药性分析[J].热带医学杂志,2016,16(4):452-455.
[7]贺逸红,李玉洁,刘海兰.白细胞、C-反应蛋白、降钙素原联合检测在开放性骨折并发感染诊断中的应用价值[J].河北医药,2016,38(14):2152-2154.
[8]刘立柱,宋世锋,张伟,等.开放性骨折患者创面感染的病原菌分布与药敏分析[J].中华医院感染学杂志,2016,26(15):3505-3507.
[9]黄聿峰,魏林文.降钙素原在骨折手术部位感染中的诊断价值研究[J].中国当代医药,2016,23(31):53-55.
[10]王宇强,贾永森,苏学涛,等.开放性骨折患者术后感染病原菌分布及对血清MMPs,SDF-1,VEGF和(下转第232页)TNF-α表达影响研究[J].临床和实验医学杂志,2016,15(22):2223-2226.
[11]卜文君,郑莉丽,钟奕,等.开放性骨折感染患者血清促炎及抗炎因子表达研究[J].中华医院感染学杂志,2017,27(4):846-848,879.
[12]胡居正,石展英,杨成志.T淋巴细胞亚群与四肢骨折感染的相关性研究[J].重庆医学,2017,46(29):4153-4155.
[13]张立营,沈伟,高鹏,等.开放性骨折感染患者CD64指数白细胞介素-6和降钙素原测定的临床价值[J].山西医药杂志,2016,45(9):1100-1102.
[14]朱振标,张寿,金旭红,等.骨折延迟愈合患者IGF-1、PDGF、ALP、PINP、β-CTX水平变化的研究[J].重庆医学,2015,44(21):2915-2917,2920.
[15]符小玉,陈小芬,林白浪,等.开放性创伤手术切口感染患者血清炎性因子水平变化分析[J].中华医院感染学杂志,2017,27(2):351-354.
[16]Schindeler A,Yu NY,Cheng TL,et al.Local delivery of the cationic steroid antibiotic CSA-90 enables osseous union in a rat openfracture model of Staphylococcus aureus infection[J].J Bone Joint Surg Am,2015,97(4):302-309.
[17]Fernandes Mde C,Peres LR,de Queiroz AC Jr,et al.Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma[J].Acta Ortop Bras,2015,23(1):38-42.
[18]林文琛,林伟东,王育新,等.Pilon骨折延期手术治疗效果及术后感染病原菌分析[J].中华医院感染学杂志,2017,27(11):2555-2557,2561.
[19]周正楠,张岩,邱旭升,等.骨折愈合过程中VEGF的表达与调控及其作用的研究进展[J].中国矫形外科杂志,2015,23(24):2248-2251.
[20]唐周舟,许永涛,马亮.糖尿病大鼠骨折愈合过程中VEGF、BMP-2及BMP-7的动态观察[J].河北医药,2016,38(9):1297-1299.
[2]王宇强,贾永森,苏学涛,等.开放性骨折患者术后感染病原菌分布及对血清MMPs,SDF-1,VEGF和TNF-α表达影响研究[J].临床和实验医学杂志,2016,15(22):2223-2226.
[3]田梦,于从军,李凯,等.开放性骨折患者发生医院感染的临床特征及危险因素分析[J].现代生物医学进展,2016,16(22):4342-4344,4206.
[4]李筱轶,秦瑾,张虎波,等.开放性骨折术后伤口感染的危险因素分析[J].中华老年骨科与康复电子杂志,2017,3(2):85-90.
[5]王韬,晏新,扶世杰,等.开放性骨折患者医院感染临床分析及预防措施[J].中华医院感染学杂志,2015,25(10):2291-2293.
[6]赖晓虹,陈丽丹,黄晓燕,等.1 261例骨科感染患者病原菌分布及耐药性分析[J].热带医学杂志,2016,16(4):452-455.
[7]贺逸红,李玉洁,刘海兰.白细胞、C-反应蛋白、降钙素原联合检测在开放性骨折并发感染诊断中的应用价值[J].河北医药,2016,38(14):2152-2154.
[8]刘立柱,宋世锋,张伟,等.开放性骨折患者创面感染的病原菌分布与药敏分析[J].中华医院感染学杂志,2016,26(15):3505-3507.
[9]黄聿峰,魏林文.降钙素原在骨折手术部位感染中的诊断价值研究[J].中国当代医药,2016,23(31):53-55.
[10]王宇强,贾永森,苏学涛,等.开放性骨折患者术后感染病原菌分布及对血清MMPs,SDF-1,VEGF和(下转第232页)TNF-α表达影响研究[J].临床和实验医学杂志,2016,15(22):2223-2226.
[11]卜文君,郑莉丽,钟奕,等.开放性骨折感染患者血清促炎及抗炎因子表达研究[J].中华医院感染学杂志,2017,27(4):846-848,879.
[12]胡居正,石展英,杨成志.T淋巴细胞亚群与四肢骨折感染的相关性研究[J].重庆医学,2017,46(29):4153-4155.
[13]张立营,沈伟,高鹏,等.开放性骨折感染患者CD64指数白细胞介素-6和降钙素原测定的临床价值[J].山西医药杂志,2016,45(9):1100-1102.
[14]朱振标,张寿,金旭红,等.骨折延迟愈合患者IGF-1、PDGF、ALP、PINP、β-CTX水平变化的研究[J].重庆医学,2015,44(21):2915-2917,2920.
[15]符小玉,陈小芬,林白浪,等.开放性创伤手术切口感染患者血清炎性因子水平变化分析[J].中华医院感染学杂志,2017,27(2):351-354.
[16]Schindeler A,Yu NY,Cheng TL,et al.Local delivery of the cationic steroid antibiotic CSA-90 enables osseous union in a rat openfracture model of Staphylococcus aureus infection[J].J Bone Joint Surg Am,2015,97(4):302-309.
[17]Fernandes Mde C,Peres LR,de Queiroz AC Jr,et al.Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma[J].Acta Ortop Bras,2015,23(1):38-42.
[18]林文琛,林伟东,王育新,等.Pilon骨折延期手术治疗效果及术后感染病原菌分析[J].中华医院感染学杂志,2017,27(11):2555-2557,2561.
[19]周正楠,张岩,邱旭升,等.骨折愈合过程中VEGF的表达与调控及其作用的研究进展[J].中国矫形外科杂志,2015,23(24):2248-2251.
[20]唐周舟,许永涛,马亮.糖尿病大鼠骨折愈合过程中VEGF、BMP-2及BMP-7的动态观察[J].河北医药,2016,38(9):1297-1299.