胆道结石术后继发急性胆管炎病原菌及sCD14-ST和IL-8的诊断价值

Pathogenic bacteria and diagnostic value of sCD14-ST and IL-8 in secondary acute cholangitis after biliary calculi

目的探讨胆道结石术后继发急性胆管炎病原菌及可溶性CD14亚型(sCD14-ST)、白细胞介素-8(IL-8)的诊断价值。方法选择海南医学院第一附属医院2017年1月-2019年6月收治的胆道结石术后继发急性胆管炎患者62例作为研究对象,纳入研究组,选择同期医院收治的胆道结石术后未继发急性胆管炎的患者60例设为对照组;对研究组患者病原菌进行统计;比较不同急性胆管炎程度、不同预后结局患者血清sCD14-ST、IL-8水平;采用受试者工作特征曲线评估血清sCD14-ST、IL-8水平对于患者不良预后的诊断价值。结果 62例患者共培养分离病原菌67株,其中革兰阴性菌43株占64.18%,革兰阳性菌21株占31.34%,真菌3株占4.48%,以大肠埃希菌为主;重度急性胆管炎患者血清sCD14-ST、IL-8分别为(91.38±25.67)pg/ml、(45.28±13.61)pg/ml高于中度患者分别为(74.34±19.65)pg/ml、(32.06±10.44)pg/ml及轻度患者(P均<0.001),中度患者血清sCD14-ST、IL-8水平高于轻度患者(P均<0.001);预后不良患者急性胆管炎血清sCD14-ST、IL-8分别为(89.84±25.09)pg/ml、(41.94±12.28)pg/ml高于预后良好患者(P<0.05);sCD14-ST、IL-8对胆道结石术后急性胆管炎患者预后的截断值分别为65.65、29.31 pg/ml,其曲线下面积分别为0.841、0.768。结论胆道结石术后继发急性胆管炎病原以革兰阴性菌为主;运用血清sCD14-ST、IL-8可较好区分疾病严重程度,且对患者预后具有一定预测价值。

OBJECTIVE To investigate the pathogenic characteristics and the diagnostic value of soluble CD14 subtype(sCD14-ST) and interleukin-8(IL-8) of secondary acute cholangitis infection after biliary calculus. METHODS Sixty-two patients with acute cholangitis after choledocholithiasis admitted to the operation room of the First Affiliated Hospital of Hainan Medical College from Jan. 2017 to Jun. 2019 were selected as the research subject and included in the study group. Sixty patients who did not develop acute cholangitis after biliary calculi in the same period of the hospital were used as the control group;the pathogenic distribution characteristics of the patients in the study group were counted;the serum sCD14-ST and IL-8 levels of patients with different acute cholangitis severity and different prognosis outcomes were compared;The receiver operating characteristic curve was used to evaluate the diagnostic value of serum sCD14-ST and IL-8 levels for the poor prognosis of patients. RESULTS A total of 67 strains of pathogenic bacteria were co-cultured and isolated from 62 patients, of which 43 strains of gram-negative bacteria accounted for 64.18%, 21 strains of gram-positive bacteria accounted for 31.34%, and 3 strains of fungi accounted for 4.48%, mainly Escherichia coli;The serum sCD14-ST and IL-8 in patients with severe acute cholangitis were(91.38±25.67)pg/ml and(45.28±13.61)pg/ml, respectively, significantly higher than those of moderate patients(74.34±19.65 pg/ml and 32.06±10.44 pg/ml, respectively) and mild patients(both P<0.001), the levels of serum sCD14-ST and IL-8 in the moderate group were significantly higher than those in the mild group(P<0.001);the levels of serum sCD14-ST and IL-8 of patients with acute cholangitis in the poor prognosis group were(89.84±25.09)pg/ml and(41.94±12.28)pg/ml, respectively, significantly higher than those of patients with good prognosis(P<0.05);the cut-off values of sCD14-ST and IL-8 on the prognosis of patients with acute cholangitis after biliary stone surgery were 65.65 and 29.31 pg/ml, respectively, and the areas under the curve were 0.841 and 0.768, respectively. CONCLUSION The main cause of acute cholangitis after biliary calculi was Gram-negative bacteria;the use of serum sCD14-ST and IL-8 can better distinguish the severity of the disease and has a certain predictive value for the prognosis of patients.