骨科医院感染患者T淋巴细胞亚群及细胞因子变化的研究

Changes of T lymphocyte subsets and cytokines in orthopedic patients with nosocomial infections

目的探讨T淋巴细胞亚群及细胞因子水平变化在骨科医院感染患者中的临床价值。方法选取2013年1月-2015年12月医院收治的50例骨科医院感染患者作为感染组,另选取同期在医院进行治疗的50例骨科非感染患者作为非感染组,分析骨科医院感染患者病原菌种类及两组T淋巴细胞亚群变化情况和细胞因子变化情况。结果 50例骨科医院感染患者共检出病原菌49株,其中革兰阴性菌28株占57.14%,以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌20株占40.82%,以金黄色葡萄球菌、表皮葡萄球菌为主;真菌1株占2.04%。感染组T淋巴细胞亚群CD3^+(55.28±3.35)%、CD4^+(34.01±6.32)%、CD4^+/CD8^+(1.52±0.21)水平较非感染组CD3^+(60.21±2.03)%、CD4^+(40.18±7.05)%、CD4^+/CD8^+(1.74±0.25)均明显降低(P<0.05);感染组细胞因子IL-4(2.40±0.23)%、IL-6(3.11±0.35)%较非感染组(2.12±0.27)%、(2.64±0.30)%水平均明显升高(P<0.05);两组CD8^+,IL-17,IFN-γ水平,差异均无统计学意义。结论骨科医院感染患者T淋巴细胞亚群CD3^+和CD4^+水平,细胞因子IL-4、IL-6、IL-17和IFN-γ水平的监测,对患者术后感染情况的评估具有一定的参考价值。

OBJECTIVE To probe into the clinical application value of changes of T lymphocyte subsets and cytokines in orthopedic patients with nosocomial infections.METHODS From Jan.2013 to Dec.2015,50 orthopedic patients with nosocomial infections were selected as infection group in the hospital.During the same time,50 noninfected orthopedic patients were selected as non-infection group in the hospital.The distribution of pathogens in orthopedic patients with nosocomial infections was analyzed,and changes of T lymphocyte subsets and cytokines in orthopedic patients with nosocomial infections were compared and analyzed.RESULTS In 50 orthopedic patients with nosocomial infections,there were 49 pathogens detected.The gram-negative bacteria were 28 strains,accounting for 57.14%,which mainly included Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae.The gram-positive bacteria were 20 strains,accounting for 40.82%,which mainly included Staphylococcus aureus and Staphylococcus epidermidis.The fungus was 1strain,accounting for 2.04%.The levels of T lymphocyte subsets of CD3~＋,CD4~＋and CD4~＋/CD8~＋in infection group were（55.28±3.35）%,（34.01±6.32）%and（1.52±0.21）,which were lower than（60.21±2.03）%,（40.18±7.05）%and and（1.74±0.25）in non-infection group,and the differences were significant（P〈0.05）.The levels of cytokines of IL-4and IL-6in infection group were were（2.40 ± 0.23）% and（3.11 ± 0.35）%,which were higher than（2.12±0.27）% and（2.64±0.30）%in non-infection group（P〈0.05）.The levels of CD8~＋,IL-17 and IFN-γbetween the two groups had no significant difference.CONCLUSIONThe monitoring of T lymphocyte subsets of CD3~＋and CD4~＋levels and cytokines of IL-4,IL-6,IL-17 and IFN-γlevels have a certain reference value for the evaluation of postoperative infections for orthopedic patients with nosocomial infection.