急性胰腺炎患者腹腔感染血清炎症因子与Ghrelin及影响因素分析
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摘要
目的探讨急性胰腺炎腹腔感染患者病原菌与影响因素及血清超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和生长激素释放肽(Ghrelin)水平变化的临床意义。方法选择医院2013年8月-2017年8月收治的急性胰腺炎患者189例为研究对象,分析腹腔感染患者病原菌与影响因素,并分析患者hs-CRP、PCT、IL-6、TNF-α和Ghrelin水平。结果 189例急性胰腺炎患者,腹腔感染32例,共培养分离病原菌51株,其中革兰阴性菌30株占58.82%、革兰阳性菌19株占37.25%,真菌2株占3.92%;合并多器官功能障碍综合征、合并低氧血症和序贯器官衰竭(SOFA)评分是急性胰腺炎患者腹腔感染的影响因素(P<0.001);腹腔感染患者血清hs-CRP、PCT、IL-6、TNF-α和Ghrelin分别为(43.21±5.98)mg/L、(5.48±1.20)μg/L、(26.21±3.14)ng/L、(5.32±1.04)mg/L、(442.14±27.98)ng/L高于未感染患者(P<0.001)。结论急性胰腺炎腹腔感染患者分离病原菌以革兰阴性菌为主,且腹腔感染患者血清hs-CRP、PCT、IL-6、TNF-α和Ghrelin水平较高,腹腔感染受多因素影响,临床应根据影响因素采取针对性措施。
OBJECTIVE To investigate the distribution of pathogens and risk factors of abdominal infection in patients with acute pancreatitis,and the clinical significance of changes in serum high-sensitivity C reactive protein(hs-CRP),procalcitonin(PCT),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and growth hormone releasing peptide(Ghrelin)levels.METHODS 189 cases of acute pancreatitis patients treated in the hospital from Aug.2013 to Aug.2017 were selected as the research objects.The pathogens and risk factors of abdominal infection were analyzed.The levels of hs-CRP and PCT were determined by immunofluorescence.The levels of IL-6,TNF-αand Ghrelin were measured by ELISA.RESULTS Among 189 patients with acute pancreatitis,32 had abdominal infection and 51 strains of pathogens were isolated.Among them,30 strains of gram-negative bacteria,19 strains of gram-positive bacteria and 2 strains of fungi accounted for 58.82%,37.25%and 3.92%respectively.Multiple organ dysfunction syndrome,hypoxemia and Sequential Organ Failure Assessment(SOFA)score were the influencing factors of abdominal infection in patients with acute pancreatitis(P<0.001).The serum levels of hs-CRP,PCT,IL-6,TNF-a and Ghrelin in patients with abdominal infection were(43.21±5.98)mg/L,(5.48±1.20)ug/L,(26.21±3.14)ng/L,(5.32±1.04)ng/L,(442.14±27.98)ng/L,respectively,significantly higher than those of uninfected patients(P<0.001).CONCLUSION The pathogens isolated from acute pancreatitis patients with abdominal infection are mainly gram-negative bacteria,and the levels of serum hs-CRP,PCT,IL-6,TNF-α,and Ghrelin are significantly increased in patients with abdominal infection.Abdominal infection is affected by many factors,and the clinicians should take targeted countermeasures based on the influencing factor.
OBJECTIVE To investigate the distribution of pathogens and risk factors of abdominal infection in patients with acute pancreatitis,and the clinical significance of changes in serum high-sensitivity C reactive protein(hs-CRP),procalcitonin(PCT),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and growth hormone releasing peptide(Ghrelin)levels.METHODS 189 cases of acute pancreatitis patients treated in the hospital from Aug.2013 to Aug.2017 were selected as the research objects.The pathogens and risk factors of abdominal infection were analyzed.The levels of hs-CRP and PCT were determined by immunofluorescence.The levels of IL-6,TNF-αand Ghrelin were measured by ELISA.RESULTS Among 189 patients with acute pancreatitis,32 had abdominal infection and 51 strains of pathogens were isolated.Among them,30 strains of gram-negative bacteria,19 strains of gram-positive bacteria and 2 strains of fungi accounted for 58.82%,37.25%and 3.92%respectively.Multiple organ dysfunction syndrome,hypoxemia and Sequential Organ Failure Assessment(SOFA)score were the influencing factors of abdominal infection in patients with acute pancreatitis(P<0.001).The serum levels of hs-CRP,PCT,IL-6,TNF-a and Ghrelin in patients with abdominal infection were(43.21±5.98)mg/L,(5.48±1.20)ug/L,(26.21±3.14)ng/L,(5.32±1.04)ng/L,(442.14±27.98)ng/L,respectively,significantly higher than those of uninfected patients(P<0.001).CONCLUSION The pathogens isolated from acute pancreatitis patients with abdominal infection are mainly gram-negative bacteria,and the levels of serum hs-CRP,PCT,IL-6,TNF-α,and Ghrelin are significantly increased in patients with abdominal infection.Abdominal infection is affected by many factors,and the clinicians should take targeted countermeasures based on the influencing factor.
引文
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[12] Liu C,Li M,Cao S,et al.Effects of HV-CRRT on PCT,TNF-α,IL-4,IL-6,IL-8and IL-10in patients with pancreatitis complicated by acute renal failure[J].Exp Ther Med,2017,14(4):3093-3097.
[13] Sun C,Fan H,Jianbin GE.Effect of Xuebijing injection on serum concentrations of TNF-α,IL-1βand IL-6in patients with acute pancreatitis[J].J Clin Med Pract,2013,13(7):R59.
[14]徐兆军,别华容,田敏,等.生长抑素联合前列地尔对重症急性胰腺炎患者的疗效及对TNF-αIL-6的影响[J].河北医学,2016,22(2):266-269.
[15]马军,樊华,寇建涛,等.血清Ghrelin监测在急性胰腺炎患者严重度评估中的意义[J].中华医学杂志,2013,93(48):3864-3866.
[2]陶福正,陈仁辉,陈英姿,等.重症急性胰腺炎腹腔感染不同抗菌药物治疗方案的成本-疗效分析[J].中华医院感染学杂志,2015,25(9):2004-2006.
[3] Wang HL,Yu KJ.Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis[J].World J Gastroenterol,2015,21(20):6304-6309.
[4] Biczo G,Hegyi P,Berczi S,et al.Inhibition of arginase activity ameliorates L-arginine-induced acute pancreatitis in rats.[J].Pancreas,2010,39(6):868-874.
[5]李科军,向正国,陈旭峰,等.早期大剂量乌司他丁联合奥曲肽治疗对重症急性胰腺炎患者炎症因子和T淋巴细胞的影响[J].海南医学院学报,2015,21(7):929-932.
[6]中华医学会外科学分会胰腺外科学组.重症急性胰腺炎诊治原则草案[J].中华外科杂志,2001,39(12):963-964.
[7]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):314-320.
[8] Noel P,Patel K,Durgampudi C,et al.Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections[J].Gut,2016,65(1):100-111.
[9]王琼,杨晓钟,戴伟杰,等.重症急性胰腺炎患者腹腔感染病原菌分布与危险因素分析[J].中华医院感染学杂志,2015,25(23):5346-5348.
[10] Lai SW,Lin CL,Liao KF,et al.Amiodarone use and risk of acute pancreatitis:apopulation-based case-control study.[J].Heart Rhythm,2015,12(1):163-166.
[11]曾雪云,毛兴龙,钱军,等.重症急性胰腺炎伴腹腔感染患者易感因素分析[J].中华医院感染学杂志,2016,26(18):4173-4175.
[12] Liu C,Li M,Cao S,et al.Effects of HV-CRRT on PCT,TNF-α,IL-4,IL-6,IL-8and IL-10in patients with pancreatitis complicated by acute renal failure[J].Exp Ther Med,2017,14(4):3093-3097.
[13] Sun C,Fan H,Jianbin GE.Effect of Xuebijing injection on serum concentrations of TNF-α,IL-1βand IL-6in patients with acute pancreatitis[J].J Clin Med Pract,2013,13(7):R59.
[14]徐兆军,别华容,田敏,等.生长抑素联合前列地尔对重症急性胰腺炎患者的疗效及对TNF-αIL-6的影响[J].河北医学,2016,22(2):266-269.
[15]马军,樊华,寇建涛,等.血清Ghrelin监测在急性胰腺炎患者严重度评估中的意义[J].中华医学杂志,2013,93(48):3864-3866.