前列腺电切术术后感染病原菌分布及对细胞凋亡蛋白的影响

The prevalence of pathogens and their effects on apoptosis-related proteins after transurethral resection of the prostate

目的探讨良性前列腺增生患者前列腺电切术后感染病原菌的分布情况,分析其对细胞凋亡蛋白的影响,为术后感染的防治提供参考。方法选取行前列腺电切术治疗的良性前列腺增生患者88例,取手术切口分泌物和中段尿作细菌及真菌检测,分析术后感染影响因素、病原菌分布以及对细胞凋亡相关蛋白Caspase9/β、Bax/β及Bcl2/β的影响,比较感染组与非感染组患者血清MCP1、FGF2、FGF7以及FGF10水平。结果 88例患者术后发生感染59例,其中感染组中,手术切口感染37例,下尿路感染14例,下尿路并切口感染8例,术后感染率为67.05%,且感染多发于大年龄、手术时间和导尿管留置时间长及合并症较多的患者。感染者中,细菌感染51例,真菌感染2例,真菌并细菌感染6例。分离病原菌共75株,其中革兰阴性菌39株(52.00%),革兰阳性菌28株(37.33%)。与未感染组比较,感染组血清MCP1、FGF2、FGF7及FGF10水平显著升高(P<0.05),Caspase9/β、Bax/β蛋白显著升高(P<0.05),抑制凋亡蛋白Bcl2/β水平显著下降(P<0.05)。结论前列腺增生患者行前列腺电切术后感染微生物多为细菌,如肺炎克雷伯菌、粪肠球菌、屎肠球菌、大肠埃希菌等。感染可导致炎性因子及促凋亡蛋白升高,抑制凋亡蛋白下降。因此可根据感染特点做进行干预及防治。

Objectives To investigate the prevalence of pathogenic bacteria in patients with benign prostatic hyperplasia after transurethral resection of the prostate and to analyze their effects on apoptosis-related proteins in order to provide a reference for prevention and treatment of postoperative infections. Methods Subjects were 88 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate. Wound secretion and urine samples were col- lected for detection of bacteria and fungi. Factors influencing the development of a postoperative infection, the distribution of pathogens, and their effects on the apoptosis-related proteins caspase 9/β, Bax/β, and Bel2/β were analyzed. Levels of MCP1, FGF2, FGF7, and FGF10 in serum from infected patients and uninfected patients were compared. Results Of the 88 patients, 59 developed an infection after surgery. Thirty-seven patients had a wound infection, 14 had a urinary tract infection, and 8 had a urinary tract infection and a wound infection. The rate of postoperative infection was 67. 05%, and infections were more common in older patients, in patients with a longer operating time, in patients with an in- dwelling catheter for a longer amount of time, and in patients with more complications. Among the infected patients, 51 had a bacterial infection, 2 had a fungal infection, and 6 had both a fungal and a bacterial infection. Seventy-five strains of pathogenic bacteria were isolated, 39 （52%） of which were Gram-negative bacteria and 28 （37. 33%0） of which were Gram-positive bacteria. Compared to uninfected patients, infected patients had significantly （P〈0.05） higher levels of serum MCP1, FGF2, FGF7 and FGF10, significantly （P〈0.05） higher levels of caspase 9/13 and Bax/β protein, and sig- nificantly （P〈0.05） lower levels of the apoptosis-related protein Bcl2/β （P〈0.05）. Conclusion Patients with benign prostatic hyperplasia who developed an infection after resection of the prostate were mostly infected with bacteria, such as Klebsiella pneumoniae, Enterococcus faecalis, Enterococcus faecium, and Escherichia coll. An infection can lead to an in- crease in inflammatory factors and proapoptotic proteins and inhibit a decrease in apoptosis-related proteins. Therefore,an infection can be prevented and controlled depending on its characteristics.