口腔颌面部间隙感染病原学及其影响因素

Etiological characteristics and influencing factors for oral and maxillofacial space infection

目的 探讨口腔颌面部间隙感染病原菌分布特征及其影响因素。方法 选取2019年1月-2021年3月青海大学附属医院口腔颌面部间隙感染患者107例为感染组。选取同期未发生口腔颌面部间隙感染的口腔颌面外科住院患者55例为对照组。分析患者口腔颌面部间隙感染的部位、感染源、病原菌分布特征。收集白细胞计数(WBC)、血小板计数(PLT)、中性粒细胞/淋巴细胞比值(NLR)、高敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、D-二聚体(D-D)、血沉(ESR)、巨噬细胞炎症蛋白-2(MIP-2)、淀粉样蛋白A(SAA)、快速序贯器官衰竭评分(qSOFA)、急性生理与慢性健康评分Ⅱ(APACHE-Ⅱ)等资料。进行受试者工作特征曲线(ROC)曲线分析、口腔颌面部间隙感染的影响因素分析。结果 在感染源方面,有牙源性感染、腺源性感染、外伤性感染、医源性感染。在感染部位方面,单间隙感染占79.44%,多间隙感染占20.56%。分离出121株病原菌,革兰阳性菌占60.33%,革兰阴性菌占39.67%。感染组WBC、体温、血清hs-CRP、PCT、MIP-2水平均高于对照组(P<0.05)。WBC、hs-CRP、PCT、MIP-2、体温是发生口腔颌面部间隙感染的独立影响因素(P<0.05)。结论 WBC、hs-CRP、PCT、MIP-2、体温是发生口腔颌面部间隙感染的独立影响因素,对诊断口腔颌面部间隙感染有较高价值。

OBJECTIVE To explore the etiological characteristics and influencing factors for oral and maxillofacial space infection. METHODS 107 patients with oral and maxillofacial space infection in Qinghai University Affiliated Hospital from Jan 2019 to Mar 2021 were recruited and divided into the infected group. Another 55 patients without oral and maxillofacial space infection who were hospitalized in the Department of Oral and Maxillofacial surgery were selected as the control group. The infection sites, sources of infection, and distribution characteristics of pathogenic bacteria were analyzed. White blood cell count(WBC), platelet count(PLT), neutrophil to lymphocyte ratio(NLR), high sensitivity C-reactive protein(hs-CRP), procalcitonin(PCT), D-dimer(D-D), erythrocyte sedimentation rate(ESR), macrophage inflammatory protein-2(MIP-2), amyloid A(SAA), quick-sequential organ failure assessment(qSOFA) scores, acute physiology and chronic health evaluation-Ⅱ(APACHE-Ⅱ) scores were recorded. The receiver operating characteristic(ROC) curve analysis was performed, and the influencing factors for the oral and maxillofacial space infection were analyzed. RESULTS The sources of infection included odontogenic infection, glandular infection, traumatic infection and iatrogenic infection. After infection site analysis, there were 79.44% with single-space infection and 20.56% with multiple-space infection. 121 strains of pathogenic bacteria were isolated, with Gram-positive bacteria accounting for 60.33% and Gram-negative bacteria accounting for 39.67%. The WBC, body temperature, serum hs-CRP, PCT and MIP-2 levels in the infected group were significantly higher than those in the control group(P<0.05). WBC, hs-CRP, PCT, MIP-2 and body temperature were independent influencing factors for the oral and maxillofacial space infection(P<0.05). CONCLUSION WBC, hs-CRP, PCT, MIP-2 and body temperature are the independent influencing factors for the oral and maxillofacial space infection and have high value in diagnosis of the oral and maxillofacial space infection.