不同细菌感染引起的脓毒血症患者炎症因子水平

Study on inflammatory factors in sepsis patients caused by different bacterial infections

目的 探讨不同细菌感染引起的脓毒血症中患者炎症因子水平。方法 选取2017年10月-2020年10月于襄阳市中西医结合医院住院并治疗的脓毒血症患者152例为研究对象,同期无发热感染症状的健康体检者50名为对照组,分析脓毒血症患者感染病原菌分布,采集健康体检者体检当天及脓毒症患者进行抗菌治疗前外周血,检测白细胞(WBC)、淋巴细胞(LYM)、中性粒细胞(NE)、嗜酸性粒细胞(EOS)、嗜碱性粒细胞(BAS)计数,炎症因子降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、IL-10、肿瘤坏死因子-α(TNF-α)、核因子-κB(NF-κB)、Toll样受体4(TLR4)水平。结果 152例脓毒症患者根据不同细菌感染分为革兰阴性菌感染81例、革兰阳性菌感染71例;革兰阳性菌组急性生理与慢性健康评分Ⅱ(APACHEII)为(21.16±5.72)分高于革兰阴性菌组(P<0.05);感染组WBC、LYM、NE、EOS、BAS指标水平均高于对照组(P<0.05),革兰阴性菌组WBC、LYM、EOS、BAS高于革兰阳性菌组,NE低于革兰阳性菌(P<0.05);感染组上述炎症因子水平均高于对照组(P<0.05);革兰阴性菌组PCT、CRP、TNF-α、NF-κB、TLR4水平高于革兰阳性菌组,IL-6、IL-10低于革兰阳性菌组(P<0.05)。结论 革兰阴性菌感染引起的脓毒血症炎症细胞与炎症因子升高较革兰阳性菌明显,PCT、CRP、TNF-α、NF-κB、TLR4的高表达,激发相关炎症因子的释放,引起严重病理损伤,更易引起患者发生转重或休克。

OBJECTIVE To investigate the inflammatory factors in sepsis patients caused by different bacterial infections. METHODS A total of 152 patients with sepsis who were hospitalized and treated in Xiangyang Hospital of Integrated Traditional Chinese and Western Medicine from Oct 2017 to Oct 2020 were selected as the research subjects, and 50 healthy subjects who had no symptoms of fever and infection during the same period were selected as the control group. The distribution of infectious pathogens in patients with sepsis was analyzed, the peripheral blood of healthy people on the day of the physical examination and patients with sepsis before antibacterial treatment were collected, the counts of white blood cells(WBC), lymphocytes(LYM), neutrophils(NE), eosinophils(EOS), and basophils(BAS), and the levels of inflammatory factors procalcitonin(PCT), C-reactive protein(CRP), interleukine-6(IL-6), IL-10, tumor necrosis factor-α(TNF-α), nuclear factor κB(NF-κB) and Toll-like receptor 4(TLR-4) were detected. RESULTS According to different bacterial infections, 152 patients with sepsis were divided into 81(53%) cases of Gram-negative bacteria infection and 71(47%)cases of Gram-positive bacteria infection. The APACHEII scores of the Gram-positive bacteria group was(21.16±5.72), significantly higher than that of Gram-negative bacteria group(15.72±5.50)(P<0.05). The WBC, LYM, NE, EOS, and BAS index levels of the infection group were significantly higher than those of the control group(P<0.05), and the WBC, LYM, EOS, and BAS of the Gram-negative bacteria group were significantly higher than those of the Gram-positive bacteria group, while the NE was significantly lower than that of the Gram-positive bacteria group(P<0.05). The levels of PCT, CRP, TNF-α, IL-6, IL-10, NF-κB, and TLR4 in the infection group were significantly higher than those in the healthy physical examination group(P<0.05). The levels of PCT, CRP, TNF-α, NF-κB, and TLR4 factors of patients in the Gram-negative bacteria infection group were significantly higher than those in the Gram-positive bacteria infection group, and IL-6 and IL-10 were significantly lower than those in the gram-positive bacteria infection group(P<0.05). CONCLUSION Inflammatory cells and inflammatory factors in sepsis caused by Gram-negative bacteria infection were significantly higher than those of Gram-positive bacteria. The high expression of PCT, CRP, TNF-α, NF-κB and TLR4 stimulated the release of related inflammatory factors and caused severe pathological damage, which was more likely to cause patients become severe or shock.