先天性巨结肠术后感染病原菌分布及血清SDF-1、IL-8、IL-17水平变化的临床意义

Clinical significance of pathogenic bacteria distribution and the changes of serum SDF-1,IL-8,and IL-17 levels in postoperative infection of Hirschsprung's disease after operation.

目的观察先天性巨结肠术后患者感染病原菌的分布及血清基质细胞衍生因子-1(SDF-1)、白细胞介素-8(IL-8)、IL-17水平的变化,并探讨其临床意义。方法回顾性分析2015年1月至2020年6月西北妇女儿童医院收治的78例先天性巨结肠手术患儿作为研究对象,根据其术后并发感染与否分组,其中感染组33例,未感染组45例。感染组均行病原学检测,统计病原菌分布情况,比较不同感染程度患儿的病原菌构成比;比较感染组和未感染组患儿血清SDF-1、IL-8、IL-17水平,采用Pearson相关系数模型探究血清SDF-1、IL-8、IL-17水平与常规感染标志物[降钙素原(PCT)、C反应蛋白(CRP)]的相关性,采用受试者工作特征(ROC)曲线评价血清各指标对重症感染的诊断价值。结果感染组患儿共分离44株病原菌,革兰阴性菌占63.64%,革兰阳性菌占31.82%,真菌占4.55%;感染组患儿随感染程度加重,病原菌分布由革兰阳性菌感染为主逐渐转变为革兰阴性菌感染为主,轻度患儿革兰阳性菌株数占42.86%,中度患儿革兰阳性菌株数占35.71%,重度患儿革兰阳性菌株数占21.43%,不同感染程度患儿革兰阳性菌比较差异有统计学意义(P<0.05);感染组和未感染组患儿血清SDF-1[(625.67±70.78)ng/L vs(327.41±35.47)ng/L]、IL-8[(21.14±2.87)pg/mL vs(14.37±1.64)pg/mL]、IL-17[(17.26±4.32)pg/mL vs(5.17±1.94)pg/mL]水平比较,感染组明显高于未感染组,差异均有统计学意义(P<0.05);先天性巨结肠术后感染患儿血清SDF-1、IL-8、IL-17水平与血清PCT、CRP水平呈正相关(P<0.05);血清SDF-1、IL-8、IL-17联合诊断重度感染的曲线下面积(AUC)为0.854,大于各指标单一诊断的AUC(0.817、0.796、0.713),联合诊断的最佳敏感度为90.00%,特异度为73.91%。结论先天性巨结肠术后感染病原菌以革兰阴性菌为主,感染患儿血清SDF-1、IL-8、IL-17水平明显升高,各指标联合检测可为临床诊断重度感染提供重要参考。

Objective To observe the distribution of pathogenic bacteria and the changes of serum stromal cell-derived factor-1(SDF-1),interleukin-8(IL-8),and IL-17 levels in postoperative infection of Hirschsprung's disease,and to explore its clinical significance.Methods From January 2015 to June 2020,78 children with Hirschsprung's colon surgery admitted to the Northwest Women's and Children's Hospital were retrospectively selected as the research objects.According to whether there were concurrent infections after the operation,they were divided into 33 cases in the infected group and 45 cases in the uninfected group.The infected group was tested for pathogens,the distribution of pathogens was counted,and the composition ratio of pathogens in children with different degrees of infection was compared.The serum SDF-1,IL-8,and IL-17 levels of the infected group and the uninfected group were compared.Pearson correlation coefficient model was used to explore the correlation between serum SDF-1,IL-8,IL-17 levels and conventional infection markers(procalcitonin[PCT],C-reactive protein[CRP]).The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of each serum index for severe infection.Results A total of 44 pathogenic bacteria were isolated from children in the infected group.Gram-negative bacteria accounted for 63.64%,Gram-positive bacteria accounted for 31.82%,and fungi accounted for 4.55%.The children in the infected group increased with the degree of infection,and the distribution of pathogenic bacteria gradually changed from Gram-positive bacteria infection to Gram-negative bacteria infection.The number of Gram-positive bacteria in mild children accounted for 42.86%,the number of Gram-positive bacteria in moderate children accounted for 35.71%,and the number of Gram-positive bacteria in severe children accounted for 21.43%.There was a statistically significant difference in Gram-positive bacteria among children with different degrees of infection(P<0.05).The levels of serum SDF-1,IL-8,and IL-17 in the infected group were(625.67±70.78)ng/L,(21.14±2.87)pg/mL,(17.26±4.32)pg/mL,respectively,which were significantly higher than corresponding(327.41±35.47)ng/L,(14.37±1.64)pg/mL,(5.17±1.94)pg/mL in the uninfected group(all P<0.05).The levels of serum SDF-1,IL-8 and IL-17 in children with Hirschsprung's disease after surgery were positively correlated with serum PCT and CRP levels(P<0.05).The area under the curve(AUC)of serum SDF-1,IL-8,IL-17 combined diagnosis of severe infection was 0.854,which was greater than the AUC of each index single diagnosis(0.817,0.796,0.713);the best sensitivity of combined diagnosis was 90.00%,and the specificity was 73.91%.Conclusion The main pathogens of Hirschsprung's disease after surgery are Gram-negative bacteria.The levels of serum SDF-1,IL-8,and IL-17 in infected children are significantly increased.The combined detection of various indicators can provide an important reference for clinical diagnosis of severe infection.