关节炎患者链球菌感染免疫的临床意义

Clinical significance of Streptococcal infection immunity in patients with arthritis

目的调查关节炎患者感染链球菌耐药性及免疫指标,为临床抗感染防治及控制耐药性发展提供指导。方法选取52例链球菌感染的关节炎患者作为观察组,60例健康体检者作为对照组,检测免疫和肾功能指标,t检验进行统计学分析;采集患者关节积液、引流液、分泌物和脓液等标本,经全自动微生物鉴定系统进行链球菌感染鉴定;采用琼脂稀释法及D试验进行药敏试验;PCR法检测链球菌耐药基因。结果关节炎患者分离的52株链球菌对青霉素、苯唑西林、万古霉素高度敏感,对红霉素、克林霉素的耐药率分别为65.38%和69.23%。34株红霉素耐药菌株中,ermB、mefA、intTN916、sagA、slo3、spyA基因检出阳性率分别为91.18%、8.82%、91.18%、97.06%、82.35%、79.41%。并未检测到其他耐药基因。D试验结果表明,红霉素耐药的链球菌中,cMLs型耐药株有31株,Ms型耐药株3株,并未发现iMLs型耐药株。31株检测到ermB基因,均为cMLs型耐药链球菌;3株检测到mefA基因,均为Ms型耐药链球菌;与对照组相比,观察组CD4^(+)T淋巴细胞水平显著下降,CD19^(+)B淋巴细胞水平显著升高;免疫球蛋白IgG水平显著升高;血清炎性因子IL-6和IL-8水平显著升高,差异有统计学意义(P<0.01)。观察组Cr、BUN、UA水平分别为(5.44±1.95)mmol/L、(81.87±9.68)μmol/L、(294.98±34.88)μmol/L,与对照组相比,观察组肾功能指标Cr、BUN、UA水平显著升高,差异有统计学意义(P<0.01)。结论链球菌临床分离株对抗菌药物的高耐药程度,是由于菌体中耐药基因、接合转座子及毒力基因共同作用的结果,积极监测对耐药性控制及耐药株传播具有重要意义。

Objectives To investigate the drug resistance and immune indicators of a streptococcal infection in patients with arthritis in order to guide the clinical prevention and treatment of infections and Streptococcus’development of drug resistance.Methods Fifty-two patients with arthritis and a streptococcal infection served as the observation group,and 60 individuals undergoing a checkup served as the control group.Joint effusion,drained fluid,secretion,and pus samples were collected,and a streptococcal infection was identified by an automated microbial identification system.A drug sensitivity test was performed using the agar dilution method and a D test was performed.Drug resistance genes in Streptococcus were detected using PCR.Results Clinical isolates of Streptococcus infecting patients with arthritis were highly sensitive to penicillin,oxacillin and vancomycin,and their resistance to erythromycin was 65.38%and their resistance to clindamycin was 69.23%.The ermB gene was detected in clinical isolates of Streptococcus at a rate of 91.18%,mefA was detected at a rate of 8.82%,intTN916 was detected at a rate of 91.18%,sagA was detected at a rate of 97.06%,slo3 was detected at a rate of 82.35%,and spyA was detected at a rate of 79.41%.No other resistance genes were detected.D test results indicated that erythromycin-resistant Streptococcus included 31 cML-resistant strains and 3 M-resistant strains,but no iML-resistant strains were noted.The ermB gene was detected in 31 strains,all of which were cML-resistant Streptococcus.The mefA gene was detected in 3 strains,all of which were M-resistant Streptococcus.Compared to the control group,the CD4^(+)T lymphocyte count in the observation group decreased significantly,and the CD19^(+)B lymphocyte count increased significantly.The immunoglobulin level(IgG)increased significantly.Levels of the serum inflammatory factors IL-6 and IL-8 increased significantly,and the difference was significant according to a t test(P<0.01).In the observation group,Cr levels were 5.44±1.95 mmol/L,BUN levels were 81.87±9.68μmol/L,and UA levels were 294.98±34.88μmol/L.Compared to the control group,the observation group had significantly higher levels of Cr,BUN,and UA,and the difference in levels was significant(P<0.01).Conclusion The high degree of drug resistance of Streptococcus isolates is the result of the combined action of drug resistance genes,conjugation transposons,and virulence genes in the bacterium.Active monitoring is crucial to the control of drug resistance and the spread of drug-resistant strains.