宫颈癌患者术后尿路感染的病原体种类及免疫反应变化分析

Analysis of pathogen types and immune response of postoperative urinary tract infection in patients with cervical cancer

目的 研究宫颈癌患者术后尿路感染病原体种类,以及感染时T淋巴细胞免疫功能的变化。方法 选取2020年4月-2021年4月本院收治的宫颈癌患者86例,均接受广泛子宫切除+盆腔淋巴结清扫术。采集患者术后尿液,采用全自动细菌分析仪鉴定病原菌,根据感染情况分为感染组、未感染组,采用Logistic分析术后尿路感染的影响因素。采用流式细胞术检测患者外周血中IL-2^(+) CD4^(+)、IFN-γ^(+) CD4^(+)、TNF-α^(+) CD4^(+)等T淋巴细胞亚群水平,比较两组患者的免疫反应变化情况。结果 86例宫颈癌患者中术后发生尿路感染22例(25.58%),分离出革兰阴性菌22株,革兰阳性菌13株。主要感染病原菌大肠埃希菌7株,肺炎克雷伯菌6株,铜绿假单胞菌5株,粪肠球菌5株。单因素、多因素Logistic回归分析显示,年龄、留置尿管方式、留置尿管时间、术后尿潴留、住院时间以及IL-2^(+) CD4^(+)、IFN-γ^(+) CD4^(+)、TNF-α^(+) CD4^(+) T淋巴细胞亚群水平均是宫颈癌患者术后发生尿路感染的独立危险因素(P<0.05或P<0.01)。术前感染组IL-2^(+) CD4^(+)、IFN-γ^(+) CD4^(+)、TNF-α^(+) CD4^(+) T细胞亚群水平均低于未感染组,而术后5 d均明显增加,其中感染组增加程度显著高于未感染组(P<0.05或P<0.01)。结论 宫颈癌患者术后尿路感染病原体主要为革兰阴性菌,且感染的发生使T淋巴细胞亚群发生显著变化,免疫功能呈增强趋势。

Objective To study the types of urinary tract infection pathogens in patients with cervical cancer and the changes of T lymphocyte immune function during infection.Methods 86 patients with cervical cancer who were admitted to our hospital from April 2020 to April 2021 were selected.All patients underwent extensive hysterectomy + pelvic lymph node dissection.The postoperative urine of the patients was collected and the pathogens were identified by automatic bacterial analyzer.According to the infection,they were divided into an infected group and an uninfected group.The influencing factors of postoperative urinary tract infection were analyzed by logistics.Flow cytometry was used to detect IL-2^(+) CD4^(+),IFN-γ^(+) CD4^(+) and TNF-α^(+) CD4^(+) T lymphocyte subsets in peripheral blood,and the changes in the immune response of the two groups were compared.Results Among 86 patients with cervical cancer,22 cases(25.58%) of urinary tract infection occurred after operation,including 22 strains of Gram-negative bacteria and 13 strains of Gram-positive bacteria.The main infectious pathogens were 7 strains of Escherichia coli,6 strains of Klebsiella pneumoniae,5 strains of Pseudomonas aeruginosa and 5 strains of Enterococcus faecalis.Single factor and multivariate logistic regression analysis showed that age,indwelling catheter,indwelling catheter time,postoperative urinary retention,hospital stay and IL-2^(+)CD4^(+),IFN-γ^(+)CD4^(+),TNF-α^(+)CD4^(+) T lymph cell subsetsare were the independent risk factors for postoperative urinary tract infection in patients with cervical cancer(P<0.05 or P<0.01).The levels of IL-2^(+)CD4^(+),IFN-γ^(+)CD4^(+),TNF-α^(+)CD4^(+) T cell subsets in the preoperative infection group were lower than those in the uninfected group,but they all increased significantly at the 5 th day after surgery,and the increase in the infected group was significantly higher than that in the uninfected group(P<0.05 or P<0.01).Conclusion The pathogen of postoperative urinary tract infection in patients with cervical cancer is mainly Gram-negative bacteria.When combined with postoperative infection,the T lymphocyte subsets change significantly,and the immune function tends to increase.