奥曲肽联合硫酸奈替米星预防化脓性阑尾炎术后感染及对患者Th17/Treg失衡的影响

Preventive effect of octreotide combined with netilmicin sulfate on postoperative infection in suppurative appendicitis and its effecton Thl7/Treg imbalance

目的 探讨奥曲肽联合硫酸奈替米星对化脓性阑尾炎术后感染的预防作用及对患者辅助性T细胞17（helper T cell17,Th17）/调节性T细胞（regulatory T cells,Treg）失衡的影响。方法 选取2014年8月~2016年5月浙江象山中医医院收治的急性化脓性阑尾炎患者148例,随机分为观察组（n=74）和对照组（n=74）。2组均行腹腔镜阑尾炎切除术,术后对照组采用硫酸奈替米星联合奥硝唑抗感染,观察组同时加用醋酸奥曲肽皮下注射。检测治疗前后血清白细胞介素4（interleukin 4,IL-4）、IL-6、IL-10、IL-17、IL-23、转化生长因子β（transforming growth factorβ,TGF-β）及干扰素γ（interferonγ,IFN-γ）水平;检测Th17、Treg细胞比例及相关转录因子表达水平,分析Th17/Treg变化。结果 治疗后2组患者IL-4、IL-6、IL-10、IL-17、TGF-β均降低,IFN-γ升高（P〈0.05）,观察组各项指标改善情况优于对照组（P〈0.05）;治疗后2组患者Th17、Treg细胞比例及相关转录因子孤独核儿受体γt（orphan nuclear receptorγt,RORγt）、叉头/翼状螺旋转录因子（Forkhead box protein P3,Fox P3）表达水平降低,Th17/Treg降低（P〈0.01）,观察组各项指标低于对照组;2组患者术后切口感染、腹腔感染等不良反应发生率比较差异无统计学意义。结论 奥曲肽联合硫酸奈替米星可预防化脓性阑尾炎患者术后感染,调节Th17/Treg失衡,恢复免疫功能,且无明显不良反应。

Objective To in v es tig a te th e prev en t iv e effect of o c treo t id e comb in ed with n e ti lmic in sulfa te on p os tope rat ive infec tion in su p p u ra t iv e appendicitis and its effect on helper T cell 17（Thl7）/ regulatory T cells（Treg） imbalance. Methods 148 p a t ie n ts with a cu te su p p u ra t iv e a p p en d ic i t is in Xiangshan Hospital of Traditional Chinese Medicine from August 2014 to May 2016 were randomly divided into observation group （n, =74） and control group （ n, = 74）. All were underwent laparoscopic appendectomy surgery, the control group took netilmicin sulfate combined with ornidazole for anti-infection after operative, while the observation group added octreotide acetate subcutaneously. The levels of serum interleukin（IL） ^, IL-6 , IL - 1 0 , IL- 17,IL-23,transforming growth factor （ TGF-J3 ）,interferon 7 （ IFN -7 ） a n d T h l 7 , Treg c e l l ratio an d e x p res s io n leve ls of re la te d tran s c r ip tio n factorbefore and after treatment were detected, Thl7/Treg change were analyzed. Results The lev e ls of IL - 4 , IL-6 , IL -1 0 , IL -1 7 , TGF-（3 were decreased, IFN -7 were increased af ter treatment （ P 〈 0. 01） , the improvement of those indicator s in the observation group were supior than control group （P 〈0. 05）. Thl7, Treg cell ratio and expression levels of related transcription factor orphan nuclear receptor-yt（ ROR-yt） , Forkhead box protein P3 （Foxp3） were decrease, Thl7/Treg was reduced after treatment （P 〈0. 01） , those indexes in observation group were lower than those in control group （P 〈 0. 05 ）. The wound infection, intra-abdominal infections and other adverse events had no significant difference in two groups. Conclusions Octreot ide combined with net i lmicin sulfate can prevent postoperat ive infection in suppurat ive appendici tis, regulate Thl7/Treg imbalance, restore immune function, and no significant adverse reactions.