感染性腹泻患儿炎症因子水平的变化、病原学特点及相关危险因素分析

Analysis of changes in levels of inflammatory cytokines, etiological characteristics, and related risk factors in children with infectious diarrhea

目的研究本医院感染性腹泻患儿的炎症因子水平变化、病原学特点及相关危险因素。方法采集2018年6月至2019年1月期间在本院初步诊断为急性细菌性腹泻患儿血液标本,通过酶联免疫吸附法(ELISA)检测血清中IL-6、IL-8和TNF-α水平,采用化学发光法检测血清PCT水平,并与健康对照组相比较;同时采集患儿新鲜粪便进行细菌培养和鉴定,并采用纸片扩散法进行药敏试验。收集患儿临床资,对相关致病影响因素采用单因素分析和多因素Logistic回归分析。结果 ELISA和化学发光法测定细菌性腹泻患儿血清IL-6、IL-8、TNF-α及PCT分别为(246.71±12.41)ng/L、(85.8±20.30)ng/L、(121.58±25.86)ng/L、(2.81±0.22)ng/L,健康对照组分别为(5.03±1.53)ng/L、(3.65±5.62)ng/L、(56.47±11.23)ng/L、(0.07±0.01)ng/L,差异均有统计学意义(均P<0.05)。患儿粪便培养检出的病原菌主要为沙门菌属(占64.04%),其次是致病性大肠埃希菌(占16.85%)和志贺菌(占11.24%)。纸片扩散法测定鼠伤寒沙门菌对氨苄西林耐药率为74.67%,对头孢他啶和复方新诺明的耐药率分别为78.90%和79.51%;鼠伤寒沙门菌对复方新诺明的耐药率较高,为79.51%;致病性大肠埃希菌对头孢他啶、头孢曲松和左氧氟沙星的耐药率在25.72%至38.33%之间,对环丙沙星和复方新诺明的耐药率分别为45.76%和47.59%,对氨苄西林的耐药率为84.80%。经多因素Logistic回归分析,饭前洗手、及时处置剩饭和保持手指甲卫生是感染性腹泻的保护性因素(P<0.05或P<0.01),餐具未消毒和室内有苍蝇是导致患儿感染腹泻的重要危险因素(P<0.05或P<0.01)。结论细菌性腹泻患儿血清IL-6、IL-8、TNF-α及PCT水平显著升高。感染病原菌以沙门菌为主,其次为致病性大肠埃希菌,且存在多重耐药性。应使儿童养成饭前洗手,保持手指甲卫生,不吃剩饭等良好卫生习惯,并重视餐具消毒和室内灭蝇,以减少儿童细菌性腹泻的发生。

Objectives To study changes in inflammatory cytokines, etiological characteristics, and related risk factors in children with infectious diarrhea seen at this Hospital. Methods Subjects were children who were preliminarily diagnosed with acute bacterial diarrhea at this Hospital from June 2018 to January 2019. Blood and stool samples were collected. The levels of IL-6, IL-8, and TNF-α were determined using an enzyme-linked immunosorbent assay. Serum PCT levels were determined using chemiluminescence and compared to levels in healthy controls. Enteric pathogenic bacteria in fresh stool specimens were isolated, cultured, and identified, and drug susceptibility testing was performed using the disk diffusion method. Univariate analysis and multivariate logistic regression analysis were used to analyze relevant pathogenic factors. Results The levels of the four inflammatory factors were significantly higher in the diarrhea group than those in the control group. The main pathogenic bacteria causing an infection were Salmonella(64.04%), followed by pathogenic Escherichia coli(16.85%), and Shigella(11.24%). Salmonella typhi was highly resistant to ampicillin(74.67%), ceftazidime(78.90%), and trimethoprim-sulfamethoxazole(79.51%). S. typhimurium had the highest resistance to all antibiotics(79.51%). The resistance of pathogenic E. coli to ceftazidime, ceftriaxone, and levofloxacin ranged from 25.72% to 38.33%, while its resistance to ciprofloxacin was 45.76%, its resistance to trimethoprim-sulfamethoxazole was 47.59%, and its resistance to ampicillin was as high as 84.80%. Hand washing before meals, disposal of leftovers, and fingernail hygiene were factors protecting children from infectious diarrhea(P<0.05) while unclean tableware and the presence of flies indoors were key risk factors for infectious diarrhea(P<0.05). Conclusion The four inflammatory factors were significantly elevated in children with bacterial diarrhea. Salmonella is the main pathogen causing infectious diarrhea, followed by pathogenic E. coli. These 2 bacteria were multi-drug-resistant. In daily life, hand washing before meals, disposal of leftovers, and fingernail hygiene are factors protecting children from infectious diarrhea while unclear tableware and the presence of flies indoors are key risk factors.