胆道疾病术后胆道感染患者血浆中性粒细胞胞外诱捕网水平对病情的评估价值

Value of plasma neutrophil extratrapping net in assessment of illness condition of biliary tract disease patients with postoperative biliary tract infection

目的探讨胆道疾病术后胆道感染患者血浆中性粒细胞胞外诱捕网(NETs)水平对病情的评估价值。方法选择浙江金华广福肿瘤医院肝胆外科2018年12月-2020年12月进行胆道手术并在术后发生胆道感染患者70例为研究组,选择同期医院进行胆道手术但在术后未发生胆道感染患者75例为对照组,研究组患者按照胆道感染严重程度分为轻度、中度和重度感染组,分别为32、20和18例。采用酶联免疫吸附法检测研究组患者在胆道感染诊断当日、24、48 h,对照组患者于同一时间点血浆中NETs游离DNA(cfDNA)、髓过氧化物酶(MPO)和中性粒细胞弹性蛋白酶(NE)水平。结果研究组诊断当天、诊断24、48 h血浆NETs/cfDNA、MPO、NE水平均高于对照组(P<0.05);与诊断当天相比,诊断24、48 h水平高于诊断当天(P<0.05);轻度、中度及重度胆道感染患者血浆NETs/cfDNA、MPO、NE水平整体差异具有统计学意义(P<0.05);重度感染组NETs/cfDNA、MPO、NE水平高于中度感染组及轻度感染组,中度感染组血浆NETs/cfDNA、MPO、NE水平高于轻度感染组(P<0.05);受试者工作特征曲线(ROC)分析结果显示,血浆NETs/cfDNA、MPO、NE水平用于轻、中、重度感染的诊断,曲线下面积(AUC)均>0.60(P<0.05)。结论血浆中NETs/cfDNA、MPO、NE水平对于反映胆道疾病术后感染状态变化及疾病严重程度有良好评估价值,值得临床推广。

OBJECTIVE To explore the value of plasma neutrophil extratrapping nets(NETs) in assessment of illness condition of biliary tract disease patients with postoperative biliary tract infection. METHODS A total of 70 patients who received biliary tract surgery and had postoperative biliary tract infection in department of hepatobiliary surgery of Zhejiang Jinhua Guangfu Cancer Hospital from Dec 2018 to Dec 2020 were assigned as the study group, meanwhile, 75 patients who received biliary tract surgery but did not have postoperative biliary tract infection were chosen as the control group. The patients of the study group were divided into the mild infection group with 32 cases, the moderate infection group with 20 cases and the severe infection group with 18 cases according to the severity of biliary tract infection. The levels of cell-free DNA(cfDNA) of NETs, myeloperoxidase(MPO) and neutrophil elastase(NE) in plasma of the study group and the control group were detected by enzyme-linked immunosorbent assay on the day of diagnosis of biliary tract infection, after the diagnosis for 24 and 48 hours. RESULTS The levels of plasma NETs/cfDNA, MPO and NE of the study group were significantly higher than those of the control group on the day of diagnosis and after the diagnosis for 24 and 48 hours(P<0.05);the levels of above indexes were significantly higher after the diagnosis for 24 and 48 hours than on the day of diagnosis(P<0.05). There were significant differences in the levels of plasma NETs/cfDNA, MPO and NE among the patients with mild, moderate and sever biliary tract infection(P<0.05);the levels of NETs/cfDNA, MPO and NE of the severe infection group were significantly higher those of the moderate infection group and the mild infection group, and the levels of plasma NETs/cfDNA, MPO and NE of the moderate infection group were significantly higher than those of the mild infection group(P<0.05). The result of receiver operating characteristic(ROC) curve analysis showed that the area under curves(AUCs) of the plasma NETs/cfDNA, MPO and NE were more than 0.60 in diagnosis of mild, moderate and severe infection(P<0.05). CONCLUSION The plasma NETs/cfDNA, MPO and NE may reflect the state of postoperative infection and has high value in assessment of severity of disease, which are worthy to be promoted.