摘要
目的分析肝胆外科患者术后感染的病原菌分布及耐药性,并探讨缝隙连接蛋白40(CONNEXIN40)及基质金属蛋白酶(MMPs)的参与作用,为临床治疗提供参考。方法选择医院2010年2月-2014年2月诊治的1 654例行肝胆外科手术患者临床资料,并对肝胆外科术后感染的80例患者进行研究,分析送检样本检出的病原菌种类、耐药性,检测感染与未感染患者血清中CONNEXIN40及基质金属蛋白酶2(MMP2)和基质金属蛋白酶9(MMP9)的水平变化。结果 80例感染患者共分离出病原菌95株,其中革兰阳性菌38株占40.0%,革兰阴性菌57株占60.0%;革兰阴性菌对庆大霉素耐药率>50.0%,革兰阳性菌对青霉素G耐药率较高为63.2%,感染患者血清中MMP2、MMP9及CONNEXIN40水平增高。结论革兰阴性菌是肝胆外科患者术后感染的主要病原菌,且肝胆外科术后感染可能与患者CONNEXIN40及MMPs水平的异常相关。
OBJECTIVE To analyze the pathogen distribution and drug resistance of postoperative infections in the department of hepatobiliary surgery and the mediation of CONNEXIN40 and MMPs so as to provide reference for clinical treatment.METHODS Totally 80 cases of infected patients in our hospital were enrolled in the present study.The pathogenic bacterial types and drug resistance as well as the expression of CONNEXIN40 combined MMP2/9were assayed.RESULTS Totally 95 strains of bacteria were isolated from the patients,including 38gram-positive strains(40.0%)and 57gram-negative strains(60.0%).Gram-negative strains had a resistance of> 50.0%to gentamicin and gram-positive strains had a resistance up to 63.2%to penicillin.The serum MMP2,MMP9 and CONNEXIN40were increased in infected patients.CONCLUSIONGram-negative bacteria are the main type resulting infections in patients and this process has a close relationship with abnormal level of serum CONNEXIN40 and MMPs concentration.
引文
[1]Rodes Brown S,Martin RC 2nd.Management of liver dominant metastatic breast cancer:surgery,chemotherapy,or hepatic arterial therapy-benefits and limitations[J].Minerva Chir,2012,67(4):297-308.
[2]Koea JB,Batiller J,Patel B,et al.A phaseⅢ,randomized,controlled,superiority trial evaluating the fibrin pad versus standard of care in controlling parenchymal bleeding during elective hepatic surgery[J].HPB(Oxford),2013,15(1):61-70.
[3]Kurmann A,Wanner B,Martens F,et al.Hepatic steatosis is associated with surgical-site infection after hepatic and colorectal surgery[J].Surgery,2014,156(1):109-116.
[4]Uenishi T,Nagano H,Marubashi S,et al.The long-term outcomes after curative resection for mass-forming intrahepatic cholangiocarcinoma associated with hepatitis C viral infection:a multicenter analysis by Osaka Hepatic Surgery Study Group[J].J Surg Oncol,2014,110(2):176-181.
[5]赵宇,杨燕,张凯.缝隙连接细胞间通讯与肝细胞癌关系的研究进展[J].中国癌症防治杂志,2014,7(3):306-310.
[6]王开阳,肖樟生,蒋星星,等.急性肝功能衰竭模型大鼠缝隙连接蛋白的表达[J].中国组织工程研究与临床康复,2011,33(37):6883-6886.
[7]史美娜,栗华.氨基胍对非酒精性脂肪性肝炎大鼠TGF-β1及MMP2、TIMP2表达的影响[J].中国医院药学杂志,2013,11(24):26-29.
[8]邹美银,朱勇根,汪美华,等.白细胞介素-32和基质金属蛋白酶-2对原发性肝细胞癌的诊断价值[J].中华实验和临床感染病杂志:电子版,2013,13(6):821-824.
[9]吴健波,刁力,阎其涛,等.血管内皮生长因子-C与基质金属蛋白酶-2在肺腺癌中表达的研究[J].中国医学创新,2011,2(12):13-15.
[10]郭晓东,李捍卫,张敏,等.MMP-2、MMP-9及P53的表达在肝移植后肿瘤复发与转移预测中的价值研究[J].现代生物医学进展,2011,4(1):90-93.
[11]李陈渝,李光勤.基质金属蛋白酶与中枢神经系统感染[J].现代生物医学进展,2008,26(8):1557-1559.
[12]孙蕊,吴忠道.基质金属蛋白酶在寄生虫致脑部感染中的免疫病理作用[J].中国寄生虫学与寄生虫病杂志,2010,12(6):468-473.