严重腹腔感染患者血清炎性指标表达水平与病情严重程度的相关性分析

Study on the relationship between the changes of serum inflammatory indexes and the severity of infection in patients with severe abdominal infection

目的分析严重腹腔感染患者血清炎性指标变化与感染严重程度的相关性。方法选择2013年10月—2017年10月河北省邯郸钢铁集团有限责任公司职工医院普外科诊治的严重腹腔感染患者34例和局部感染者41例作为研究对象,分别作为严重感染组和局部感染组,另选择同期在医院体检的健康人群25例作为健康对照组。对比分析3组研究对象入院时和治疗3d后的体温(T),血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素-6(IL-6)及降钙素原(PCT)表达水平,APACHEⅡ评分、白细胞计数(WCB),并分析血清炎性指标与WBC的相关性结果入院时,严重感染组与局部感染组患者的T、WBC、CRP、TNF-α、IL-6及PCT、APACHEⅡ评分,均显著高于健康对照组(F/P=19.160/0.000、33.942/0.000、15.270/0.000、26.260/0.000、82.001/0.000、20.944/0.000、87.332/0.000);严重感染组TNF-α、IL-6、PCT及APACHEⅡ评分的表达水平,高于局部感染组(t/P=14.912/0.000、9.702/0.000、5.502/0.000、17.014/0.000);治疗3d后,2组感染患者T、WBC、CRP、TNF-α、IL-6及PCT、APACHEⅡ评分均较治疗前(入院时)显著降低(严重感染组t/P值分别为:9.257/0.000、5.018/0.000、5.059/0.000,19.629/0.000、19.066/0.000、2.632/0.011、13.625/0.000;局部感染组t/P值分别为:13.644/0.000、5.284/0.000、5.341/0.000、16.085/0.000、10.736/0.000、25.642/0.000、8.220/0.000),且治疗后严重感染组的TNF-α、IL-6、PCT水平及APACHEⅡ评分仍高于局部感染组(t/P=12.002/0.000、7.079/0.000、12.784/0.000、11.249/0.000)。经Spearman分析后结果显示,CRP、TNF-α、IL-6及PCT水平与WBC呈正相关(r=0.416、0.633、0.614、0.724,P均=0.000)。结论腹腔感染者的血清CRP、TNF-α、IL-6及PCT水平会显著升高,且其与WCB呈正相关性,在严重腹腔感染患者的诊治中具有积极意义。

Objective To analyze the correlation between the changes of serum inflammatory indexes and the severity of infection in patients with severe abdominal infetion. Methods From October 2013 to October 2017, 34 patients with severe abdominal infection diagnosed and treated in General Surgery of Workers＇ Hospital of Handan Iron and Steel Group Co,Ltd and 41 patients with local infection were selected as research objects, with serious infection（n=34） and local infection（n =41）, 25 healthy people at same period in our hospital were included as control group. Comparative analysis were performed among 3 groups of patients＇ hospitalized treatment temperature（T） after D3, serum TNF-α, CRP, IL-6 and expression levels of PCT, APACHE Ⅱ score, white blood cell count（WBC）, and analyze the correlation between serum indexes and WBC. Results The levels of T, WBC, APACHE Ⅱ, CRP, TNF-α, IL-6 and PCT in patients with severe infection and local infection were significantly higher than those in control group（F/P=19.160/0.000, F/P =33.942/0.000, F/P = 87.332/0.000, F/P= 15.270/0.000, F/P = 26.260/0.000, F/P = 82.001/0.000, F/P =20.944/0.000）. The level of APACHEⅡ, IL-6, TNF-α and PCT in patients with severe infection was significantly higher than that in patients with local infection（F/P = 17. 014/0. 3000, F/P = 9. 702/0. 000, F/P = 14. 912/0. 000, F/P=5. 502/0. 000）. After 3 days of treatment,WBC, APACHE II score, CRP, TNF-a, IL-6 and PCT were significantly lower than those before treatment（serious infection; t/P =9.257/0.000, t/P = 5. 018/0. 000, t/P = 13. 625/0. 000, t/P= 5. 059/0. 000, t/P = 19. 629/0. 000, t/P =19.066/0.000, t/P= 2. 632/0.011;local infection; t/P=13. 644/0. 000, t/P = 5. 284/0.000, t/P = 8. 220/0.000, t/P =5.341/0.000, t/P = 16.085/0.000, t/P=10. 736/0. 000, t/P =25. 642/0. 000）, and the levels of TNF-a, IL-6 and PCT were still higher in the severe infection group. In the local infection group, the difference was statistically significant（t/P =12.002/0.000, t/P =7.079/0.000, t/P =12.784/0.000, t/P = 11.290/0.000）. The results of Spearman analysis showed that CRP, TNF-α, IL-6 and PCT were positively correlated with WBC（r =0. 416, r =0. 633, r =0.614, r=0.724,P=0.000）. Conclusion Serum levels of CRP, TNF-α, IL-6 and PCT are significantly increased in patients with abdominal infection, and are positively correlated with WCB and APACHE Ⅱ scores. It is of great significance in the diagnosis and treatment of patients with severe abdominal infection.