2型糖尿病合并脑出血患者微创术后颅内感染影响因素分析及对Th1/Th2细胞平衡影响

Analysis on influencing factors of intracranial infection in patients with type 2 diabetes mellitus complicated with cerebral hemorrhage after minimally invasive surgery and its effects on Th1/Th2 cell balance

目的探讨分析2型糖尿病合并脑出血患者微创术后颅内感染的影响因素及对Th1/Th2细胞平衡影响,为临床颅内感染的预防提供依据。方法选择2015年3月-2018年4月复旦大学附属华山医院收治合并2型糖尿病的脑出血颅内血肿微创术后引流患者241例为研究对象,分析患者术后颅内感染病原菌情况,并比较颅内感染对患者凝血功能及Th1/Th2细胞平衡的影响,分析患者性别、年龄、意识障碍等临床资料,归纳糖尿病合并脑出血患者微创术后颅内感染的影响因素。结果糖尿病合并脑出血患者微创术后颅内感染率为15.35%(37/241)。共培养分离病原菌45株,其中革兰阴性菌27株占60.00%,革兰阳性菌13株占28.89%,真菌5株占11.11%。年龄、意识障碍、留置引流时间是2型糖尿病合并脑出血患者微创术后颅内感染的影响因素(P<0.05)。颅内感染患者凝血酶原时间(Prothrombin time,PT)、活化部分凝血活酶时间(Activated partial thromboplastin time,APTT)、凝血时间(time-of-coagulation,TT)、纤维蛋白原(Fibrinogen,FIB)分别为(17.94±2.17)s、(46.28±4.23)s、(20.95±3.18)s、(3.42±0.73)g/L高于无颅内感染患者(P<0.001)。颅内感染患者与无颅内感染患者Th1细胞水平差异无统计学意义(P=0.648),而颅内感染患者Th2细胞为(6.04±1.18)%高于无颅内感染患者(P<0.001),颅内感染患者Th1/Th2为(2.28±0.83)低于无颅内感染患者(P<0.001)。结论糖尿病合并脑出血微创术后颅内感染病原菌以革兰阴性菌为主,年龄、意识障碍、留置引流时间与颅内感染发生密切相关,颅内感染的发生可导致患者凝血功能及免疫功能障碍。

OBJECTIVE To investigate the relevant factors of intracranial infection in patients with type 2 diabetes mellitus complicated with cerebral hemorrhage after minimally invasive surgery and its effect on the influence of Th1/Th2 cell balance,so as to provide evidence for the prevention of intracranial infection.METHODS A total of 241 patients with type 2 diabetes mellitus complicated with intracranial hematoma after minimally invasive surgery for cerebral hemorrhage were selected as study subject in East Hospital of Huashan Hospital Affiliated to Fudan University from Mar.2015 to Apr.2018.The pathogenic bacteria of patients with intracranial infection postoperative were analyzed,and the effects of intracranial infection on coagulation function and Th1/Th2 cell balance were compared.The clinical data of gender,age,and disturbance of consciousness were also analyzed,so as to summarize the influnecing factors of intracranial infection in patients with diabetes and cerebral hemorrhage after minimally invasive surgery.RESULTS The incidence of intracranial infection in patients with diabetes and cerebral hemorrhage after minimally invasive surgery was 15.35%.A total of 45 strains of pathogenic bacteria were isolated,including 27 strains of Gram-negative bacteria(60.00%),13 strains of Gram-positive bacteria(28.89%)and 5 strains of fungi(11.11%).Age,disturbance of consciousness and time of indwelling and drainage were the influencing factors of intracranial infection in patients with type 2 diabetes mellitus complicated with cerebral hemorrhage after minimally invasive surgery(P<0.001).Prothrombin time(PT),activated partial thromboplastin time(APTT),coagulation time(TT),fibrinogen(FIB)were(17.94±2.17)s,(46.28±4.23)s,(20.95±3.18)s,and(3.42±0.73)g/L in patients with intracranial infection,respectively,significantly higher than those in patients without intracrannial infection(P<0.001).There was no significant difference in Th1 cell level between patients with intracranial infection and patients without intracranial infection(P=0.648),while Th2 cell level in patients with intracranial infection was(6.04±1.18),significantly higher than that in patients without intracranial infection(P<0.001).The Th1/Th2 in patients with intracranial infection was(2.28±0.83),significantly lower than that in patients without intracranial infection(P<0.001).CONCLUSION Gram-negative bacteria are the dominant pathogens of intracranial infection in patients with diabetes mellitus complicated with cerebral hemorrhage after minimally invasive surgery.Age,disturbance of consciousness and time of indwelling drainage are closely related to the occurrence of intracranial infection.The occurrence of intracranial infection can lead to coagulation and immune dysfunction.