剖宫产产妇术后切口感染者血清炎性应激指标与应激激素和免疫应答的相关性
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摘要
目的探讨剖宫产产妇术后切口感染者血清炎性应激指标与应激激素及免疫应答的相关性。方法选取2015年12月至2017年12月于重庆市开州区人民医院行剖宫产并发术后切口感染产妇46例作为观察组,选取同期于本院行剖宫产但术后未出现切口感染的产妇116例作为对照组,分别采集两组产妇肘静脉血5 ml,离心后取其上清液,ELISA法检测血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-8(IL-8)、血管紧张素Ⅱ(AT-Ⅱ)、皮质醇(Cor)、胰岛素(INS)以及去甲肾上腺素(NE)含量。应用流式细胞仪检测CD16~+CD25~+NK细胞、CD3~+CD4~+T细胞和CD3~+CD8~+T细胞含量;油镜下对免疫黏附促进因子(FEER)、直向肿瘤红细胞花环率(DTER)、免疫黏附抑制因子(FEIR)、肿瘤红细胞花环(ATER)和自然肿瘤红细胞花环率(NTER)计数。结果观察组产妇血清IL-6、IL-1、IL-8及TNF-α含量均高于对照组,差异均有统计学意义(t=9.057、6.432、8.746、15.072,P=0.002、0.005、0.001、0.001);观察组产妇血清CD16~+CD25~+NK细胞、CD3~+CD4~+T细胞含量低于对照组(t=3.147、6.382,P=0.026、0.001),血清CD3~+CD8~+T细胞含量高于对照组(t=10.453,P=0.008);Pearson相关分析显示,观察组产妇血清IL-8、IL-6、IL-1和TNF-α含量和血清CD3~+CD8~+T细胞、FEIR含量呈正相关,与CD16~+CD25~+NK、CD3~+CD4~+T细胞、FEER、DTER、NTER、ATER、AT-Ⅱ、Cor、INS及NE含量呈负相关(P均<0.05)。结论剖宫产产妇术后切口感染可引起炎性因子过度分泌,而机体炎症反应的异常激活与应激激素分泌及免疫应答变化密切相关。
Objective To investigate the correlation between serum inflammatory response and stress hormone and immune response in patients with postoperative cesarean section infection. Methods Total of65 cases of cesarean section complicated with postoperative incision infection from Chongqing City State District People's Hospital from December 2015 to December 2017 were selected as observation group, while116 women who underwent cesarean section in our hospital but without wound infection after operation were selected as control group. Total of 5 ml cubital venous blood of the two groups were collected, then the supernatant was collected after centrifugation. The serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), interleukin-1(IL-1), interleukin-8(IL-8), angiotensin Ⅱ(AT-Ⅱ), cortisol(Cor), insulin(INS) and norepinephrine(NE) were detected by ELISA; the content of CD16~+CD25~+ NK cells, CD3~+CD4~+ T cells and CD3~+CD8~+ T cells were detected by flow cytometry. The immunoadhesive promoting factor(FEER), the direct tumor erythrocyte rosette rate(DTER), immunoadhesive inhibitor(FEIR), tumor red blood cell garland(ATER) and natural tumor red blood cell rosette rate(NTER) count were observed under oil microscope.Results The serum levels of IL-6, IL-1, IL-8 and TNF-α of cases in observation group were higher than those of the control group, with significant differences(t = 9.057, 6.432, 8.746, 15.072; P = 0.002, 0.005,0.001, 0.001). The count of serum CD16~+CD25~+ NK cells and CD3~+CD4~+ T cells of cases in observation group were significantly lower than those of the control group(t = 3.147, 6.382; P = 0.026, 0.001), and the serum CD3~+CD8~+ T cells were significantly higher than that of control group(t = 10.453, P = 0.008).Pearson correlation analysis showed that serum IL-8, IL-6, IL-1 and TNF-α levels in the observation group were positively correlated with serum CD3~+CD8~+ T cells and FEIR levels, and counts of CD16~+CD25~+ NK,CD3~+CD4~+ T cells; but negatively correlated with the contents of FEER, DTER, NTER, ATER, AT-II, Cor,INS and NE. Conclusions The inflammatory response in cesarean section infection can significantly activate the excessive secretion of inflammatory factors, and its abnormal activation of inflammatory response and immune response changes, stress hormone secretion is closely related.
Objective To investigate the correlation between serum inflammatory response and stress hormone and immune response in patients with postoperative cesarean section infection. Methods Total of65 cases of cesarean section complicated with postoperative incision infection from Chongqing City State District People's Hospital from December 2015 to December 2017 were selected as observation group, while116 women who underwent cesarean section in our hospital but without wound infection after operation were selected as control group. Total of 5 ml cubital venous blood of the two groups were collected, then the supernatant was collected after centrifugation. The serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), interleukin-1(IL-1), interleukin-8(IL-8), angiotensin Ⅱ(AT-Ⅱ), cortisol(Cor), insulin(INS) and norepinephrine(NE) were detected by ELISA; the content of CD16~+CD25~+ NK cells, CD3~+CD4~+ T cells and CD3~+CD8~+ T cells were detected by flow cytometry. The immunoadhesive promoting factor(FEER), the direct tumor erythrocyte rosette rate(DTER), immunoadhesive inhibitor(FEIR), tumor red blood cell garland(ATER) and natural tumor red blood cell rosette rate(NTER) count were observed under oil microscope.Results The serum levels of IL-6, IL-1, IL-8 and TNF-α of cases in observation group were higher than those of the control group, with significant differences(t = 9.057, 6.432, 8.746, 15.072; P = 0.002, 0.005,0.001, 0.001). The count of serum CD16~+CD25~+ NK cells and CD3~+CD4~+ T cells of cases in observation group were significantly lower than those of the control group(t = 3.147, 6.382; P = 0.026, 0.001), and the serum CD3~+CD8~+ T cells were significantly higher than that of control group(t = 10.453, P = 0.008).Pearson correlation analysis showed that serum IL-8, IL-6, IL-1 and TNF-α levels in the observation group were positively correlated with serum CD3~+CD8~+ T cells and FEIR levels, and counts of CD16~+CD25~+ NK,CD3~+CD4~+ T cells; but negatively correlated with the contents of FEER, DTER, NTER, ATER, AT-II, Cor,INS and NE. Conclusions The inflammatory response in cesarean section infection can significantly activate the excessive secretion of inflammatory factors, and its abnormal activation of inflammatory response and immune response changes, stress hormone secretion is closely related.
引文
[1]杜彦芳,闫璐,王冬阁,等.胎盘多肽对子宫肌瘤患者T淋巴细胞亚群,NK细胞及炎症因子水平的影响[J].现代生物医学进展,2016,16(9):1734-1737.
[2]牛富国,刘雪红,侯增光,等.帕瑞昔布钠超前镇痛对剖宫产术产妇炎性因子及应激的影响[J].海南医学院学报,2016,22(19):2322-2324.
[3]袁兵.椎管内盐酸氢吗啡酮单次给药超前镇痛对剖宫产产妇镇痛效果,炎性因子及应激反应的影响[J].中国妇幼保健,2018,7(10):105-109.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):460-465.
[5]中华人民共和国卫生部医政司.全国临床检验操作规程(精)[M].3版.东南大学出版社,2006.
[6]琚晓敏,郭金风.剖宫产与阴道分娩对前次剖宫产再次妊娠产妇的应激及炎性状态分析[J].中国计划生育学杂志,2017,25(7):471-473.
[7]Ilhan G,Verit Atmaca F F,Kaya A,et al.Risk factors and microbiology of wound infections following cesarean delivery:Experience of a single institution[J].J Infect Chemother,2016,22(10):667-670.
[8]刘丽学,云海霞,王菲,等.影响剖宫产术后并发产褥感染的相关危险因素分析[J].现代生物医学进展,2016,16(3):515-518.
[9]Sasikumar C,Desai U,Joshi J M.Post-lower segment cesarean section wound infection with Mycobacterium abscessus.[J].Indian JDermatol Venereol Leprol,2017,83(3):349-350.
[10]Scheck SM,Blackmore T,Maharaj D,et al.Caesarean section wound infection surveillance:Information for action[J].Aust NZJ Obstet Gynaecol,2017,3(1):206-209.
[11]李妍,李娜.剖宫产切口感染的高危因素分析及预防策略[J].中国妇幼保健,2017,32(21):5195-5198.
[12]刘睿,刘磊,张涛红,等.剖宫产术后切口感染危险因素病例对照研究的meta分析[J].中国卫生统计,2017,34(2):269-271.
[13]Mahomed K,Ibiebele I,Buchanan J,et al.The Betadine trialantiseptic wound irrigation prior to skin closure at caesarean section to prevent surgical site infection:A randomised controlled trial[J].Aust NZJ Obstet Gynaecol,2016,56(3):301-306.
[14]朱丹,余江.剖宫产后切口感染的原因与预防措施分析[J].中国妇幼健康研究,2016,4(2):204-206.
[15]Sasikumar C,Desai U,Joshi JM.Post-lower segment cesarean section wound infection with Mycobacterium abscessus[J].Indian J Dermatol Venereol Leprol,2017,83(3):349-350.
[16]郑小玲,胡莉娜,孙亚青,等.剖宫产术后切口感染病原学特点及其危险因素分析[J].中华医院感染学杂志,2017,27(21):4978-4981.
[17]曾亚兰,绍勇,兰仲军.多种油脂肪乳(SMOF)干预对食管癌术后应激激素,炎性介质及免疫功能的影响[J].海南医学院学报,2017,23(22):3085-3088.
[18]Nabhan AF,Allam NE,Hamed ASM.Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section[J].Cochrane Database Syst Rev,2016,6(6):876-881.
[19]朱振萍,胡小林.剖宫产术抗生素应用时机对高龄产妇术后尿道和切口感染及炎症因子的表达影响分析[J].中国性科学,2016,25(12):115-118.
[20]廖宴,王玮淞,张琴玲.碘伏术前消毒阴道,术中冲洗宫腔预防急诊剖宫产术后切口感染疗效观察[J].中国性科学,2017,26(10):125-127.
[21]胡万芹,杜玲,吴灿,等.剖宫产产妇术后感染相关因素及炎症因子和T淋巴细胞亚群指标的研究[J].中华医院感染学杂志,2018,6(4):590-593.
[22]符静,许娟,张进梅.循证护理在预防剖宫产切口感染中的应用[J].山西医药杂志,2017,46(11):1384-1386.
[23]何敏芝,李益民,蔡珺,等.两种铺巾对剖宫产手术切口感染的影响研究[J].中华医院感染学杂志,2017,27(2):460-461.
[24]毛小勇,钟华平,骆志炎,等.初产妇剖宫产手术切口感染病原菌分布及其药敏分析[J].实用预防医学,2016,23(11):1360-1362.
[25]刘世舜,山洁,董美玉,等.红外线照射治疗对剖宫产术后切口感染患者感染控制与微循环改善的作用研究[J].中华医院感染学杂志,2017,27(2):418-421.
[2]牛富国,刘雪红,侯增光,等.帕瑞昔布钠超前镇痛对剖宫产术产妇炎性因子及应激的影响[J].海南医学院学报,2016,22(19):2322-2324.
[3]袁兵.椎管内盐酸氢吗啡酮单次给药超前镇痛对剖宫产产妇镇痛效果,炎性因子及应激反应的影响[J].中国妇幼保健,2018,7(10):105-109.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):460-465.
[5]中华人民共和国卫生部医政司.全国临床检验操作规程(精)[M].3版.东南大学出版社,2006.
[6]琚晓敏,郭金风.剖宫产与阴道分娩对前次剖宫产再次妊娠产妇的应激及炎性状态分析[J].中国计划生育学杂志,2017,25(7):471-473.
[7]Ilhan G,Verit Atmaca F F,Kaya A,et al.Risk factors and microbiology of wound infections following cesarean delivery:Experience of a single institution[J].J Infect Chemother,2016,22(10):667-670.
[8]刘丽学,云海霞,王菲,等.影响剖宫产术后并发产褥感染的相关危险因素分析[J].现代生物医学进展,2016,16(3):515-518.
[9]Sasikumar C,Desai U,Joshi J M.Post-lower segment cesarean section wound infection with Mycobacterium abscessus.[J].Indian JDermatol Venereol Leprol,2017,83(3):349-350.
[10]Scheck SM,Blackmore T,Maharaj D,et al.Caesarean section wound infection surveillance:Information for action[J].Aust NZJ Obstet Gynaecol,2017,3(1):206-209.
[11]李妍,李娜.剖宫产切口感染的高危因素分析及预防策略[J].中国妇幼保健,2017,32(21):5195-5198.
[12]刘睿,刘磊,张涛红,等.剖宫产术后切口感染危险因素病例对照研究的meta分析[J].中国卫生统计,2017,34(2):269-271.
[13]Mahomed K,Ibiebele I,Buchanan J,et al.The Betadine trialantiseptic wound irrigation prior to skin closure at caesarean section to prevent surgical site infection:A randomised controlled trial[J].Aust NZJ Obstet Gynaecol,2016,56(3):301-306.
[14]朱丹,余江.剖宫产后切口感染的原因与预防措施分析[J].中国妇幼健康研究,2016,4(2):204-206.
[15]Sasikumar C,Desai U,Joshi JM.Post-lower segment cesarean section wound infection with Mycobacterium abscessus[J].Indian J Dermatol Venereol Leprol,2017,83(3):349-350.
[16]郑小玲,胡莉娜,孙亚青,等.剖宫产术后切口感染病原学特点及其危险因素分析[J].中华医院感染学杂志,2017,27(21):4978-4981.
[17]曾亚兰,绍勇,兰仲军.多种油脂肪乳(SMOF)干预对食管癌术后应激激素,炎性介质及免疫功能的影响[J].海南医学院学报,2017,23(22):3085-3088.
[18]Nabhan AF,Allam NE,Hamed ASM.Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section[J].Cochrane Database Syst Rev,2016,6(6):876-881.
[19]朱振萍,胡小林.剖宫产术抗生素应用时机对高龄产妇术后尿道和切口感染及炎症因子的表达影响分析[J].中国性科学,2016,25(12):115-118.
[20]廖宴,王玮淞,张琴玲.碘伏术前消毒阴道,术中冲洗宫腔预防急诊剖宫产术后切口感染疗效观察[J].中国性科学,2017,26(10):125-127.
[21]胡万芹,杜玲,吴灿,等.剖宫产产妇术后感染相关因素及炎症因子和T淋巴细胞亚群指标的研究[J].中华医院感染学杂志,2018,6(4):590-593.
[22]符静,许娟,张进梅.循证护理在预防剖宫产切口感染中的应用[J].山西医药杂志,2017,46(11):1384-1386.
[23]何敏芝,李益民,蔡珺,等.两种铺巾对剖宫产手术切口感染的影响研究[J].中华医院感染学杂志,2017,27(2):460-461.
[24]毛小勇,钟华平,骆志炎,等.初产妇剖宫产手术切口感染病原菌分布及其药敏分析[J].实用预防医学,2016,23(11):1360-1362.
[25]刘世舜,山洁,董美玉,等.红外线照射治疗对剖宫产术后切口感染患者感染控制与微循环改善的作用研究[J].中华医院感染学杂志,2017,27(2):418-421.