口腔正畸患者感染病原菌分布、细胞因子测定及相关因素分析

Pathogen distribution,cytokine determination,and factors related to infection in orthodontic patients

目的检测接受口腔正畸的患者感染病原菌的分布及细胞因子水平,并进行相关危险因素分析。方法2016年3月一2018年9月在本院口腔科接受口腔正畸的患者150例,依据感染情况分为感染组(n=75)和未感染组(n=75),并选择健康体检者75例作为对照组,采用ELISA法检测血清细胞因子水平并进行比较分析。取口腔正畸感染者血液、口腔分泌物进行病原菌培养、鉴定以及药敏试验。收集患者相关临床资料,采用多元Logisitic回归分析法分析病原菌感染相关危险因素。结果感染组患者炎症因子Osteopontin.Fascin及IGF-1分别为(2.74±0.31)ng/mL、(6.25±0.58)pg/mL和(0.93土0.10)pg/mL,未感染组分别为(1.88±0.20)ng/mL.(5.08±0.54)pg/mL和(0.79±0.08)pg/mL,健康对照组分别为(1.17±0.12)ng/mL、(3.95±0.41)pg/mL和(0.61±0.06)pg/mL,差异均有统计学意义(P<0.05)。75例感染者共分离培养出83株病原菌,其中革兰阳性菌47株,占56.63%,主要以伴放线放线杆菌(16.87%)与牙齦卟啉单胞菌(15.67%)为主;革兰阴性菌36株,占43.37%,主要以口腔链球菌(14.46%)和表皮葡萄球菌(12.05%)为主。药敏试验显示,伴放线放线杆菌、牙龈卟啉单胞菌及肺炎克雷伯菌对头孢唑林及环丙沙星耐药,对氨苄西林钠舒巴坦钠及亚胺培南敏感;口腔链球菌、口腔链球菌对庆大霉素及红霉素耐药,对头孢曲松、万古霉索敏感。多因素Logistic回归分析显示,合并糖尿病、就诊次数≥5次、未使用--次性设备及口腔器械污染是接受口腔正畸术后感染的危险因素(P<0.05)。结论口腔正畸术后感染患者血清炎症因子水平升高,可作为辅助诊断。感染的发生与多种因素有关,如合并糖尿病等。口腔正畸术后感染的病原菌主要以革兰阴性菌为主,且对多种药物耐药。临床上需根据病原菌培养及药敏试验结果合理用药,对合并糖尿病、就诊次数较多的患者应采取相应措施控制术后感染的发生。

Objective To determine the distribution of pathogenic bacteria and the level of cytokines in orthodontic pa-tients and to analyze related risk factors.Methods Clinical data on 150 orthodontic patients seen at Linzi District People's Hospital from March 2016 to September 2018 were collected.Based on their infection status,patients were divided into those with an infection(n=75)and those without an infection(n=75),and 75 healthy people served as the control group.Serum cytokine levels were detected using ELISA and comparatively analyzed.Blood and oral secretions were col-lected from patients receiving orthodontic treatment who had an infection,and pathogenic bacteria were cultured,identi-fied,and subjected to a drug sensitivity test.The relevant clinical data on patients were collected and the risk factors for infection with pathogenic bacteria were analyzed using multiple logistic regression analysis.Results Osteopontin was 2.74±0.31 ng/ml,fascin was 6.25土0.58 pg/ml,and IGF-1 was 0.93±0.10 pg/ml in patients with an infection.Os-teopontin was 1.88±0.20 ng/ml ng/ml,fascin was 5.08±0.54 pg/ml,and IGF-1 was 0.79±0.08 pg/ml in patients without an infection.Osteopontin was 1.17±0.12 ng/ml ng/ml,fascin was 3.95±0.41 pg/mI,and IGF-1 was0.61±0.06 pg/mi in the control group.Levels differed significantly among the groups(P<0.05 for ll).Eighty-three strains of pathogenic bacteria were isolated from 75 patients with an infection.Of those strains,47(56.63%)were strains of Gram positive bacteria,which were mainly Actinobacteria(16.87%)and Porphyromonas gingivalis(15.67%).Thirty-six(43.37%)were strains of Gram-negative bacteria,which were mainly Streptococcus buccalis(14.46%)and Sta phy-lococcus epidermidis(12.05%).The drug sensitivity test indicated that Actinobacillus,Porphyromonas gingivalis,and Klebsiella pneumoniae were resistant to cefazolin and ciprofloxacin and sensitive to amicllin,sulbactam,and imipenem.S.bruccalis and S.epidermidis were resistant to gentarmicin and erythromycin and sensitive to cephalosporin and vanco-mycin.Multivariate Iogistic regression analysis indicated that having diabetes mellitus,making more than 5 visits,not u-sing disposable equipment,and contamination of oral instruments were risk factors for a postoperative infection(P<0.05).Conclusion The level of serum inflammatory factors increased in patients after orthodontic surgery,and this find-ing can be used to aid in diagnosis.The development of an infection is related to many factors,such as having diabetes mellitus.Gram-negative bacteria were the main pathogens causing an infection after orthodontic surgery,and those bacte-ria were resistant to numerous drugs.In a clinical setting,rational drug use should be based on the results of a pathogen culture and a drug sensitivity test.Corresponding measures should be taken to control postoperative infections in patients with dia betes mellitus and patients making frequent visits.