十二指肠切除术后感染危险因素及免疫功能与Th1/Th2细胞水平变化

Analysis of risk factors for infection after duodenectomy and correlation between changes of immune function and Th1/Th2

目的探讨十二指肠切除术感染危险因素及免疫功能、T辅助细胞(Th)1/Th2细胞水平变化。方法选择东营市中医院2016年2月-2021年2月收治的80例行十二指肠切除术后感染患者作为研究组,另取同期80例十二指肠切除术后未出现感染患者作为对照组,收集临床资料,分析十二指肠切除术后感染患者感染部位及病原菌分布特点,采用多因素Logistic回归分析行十二指肠切除术患者术后感染的相关因素,比较两组免疫功能、血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-2、IL-6、IL-10水平。结果80例行十二指肠切除术后感染患者中,以腹腔感染为主;80例十二指肠切除术后感染患者共培养分离病原菌106株,以革兰阴性菌为主;多因素Logistic回归分析结果显示,手术时间≥3 h(OR=2.195,P=0.004)、术中输血量≥600 ml(OR=1.772,P=0.008)、血清白蛋白<30 g/L(OR=2.438,P=0.004)、胰瘘(OR=2.385,P=0.003)、胆瘘(OR=2.085,P=0.006)、术后出血(OR=1.982,P=0.003)均为影响十二指肠切除术患者术后感染的独立危险因素(P<0.05);研究组CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)低于对照组(P<0.05);研究组血清TNF-α、IL-6、IL-10高于对照组,IL-2低于对照组(P<0.05)。结论十二指肠切除术感染的发生与多种因素密切相关,且患者免疫功能及Th1/Th2细胞水平异常,临床应重视这些特征给予防治措施。

OBJECTIVE To explore the risk factors for infection after duodenectomy and changes of immune function and T helper cells(Th)1/Th2.METHODS A total of 80 patients with infection after duodenectomy admitted to Dongying Hospital of Traditional Chinese Medicine from Feb 2016 and Feb 2021 were enrolled as the study group,and another 80 patients without infection during the same period were enrolled as the control group.Clinical data were collected to analyze the infection sites and distribution characteristics of pathogens in infection patients after duodenectomy.The related factors for postoperative infection were analyzed by multivariate logistic regression analysis.The immune function,levels of serum tumor necrosis factor-α(TNF-α),interleukin(IL)-2,IL-6 and IL-10 were compared between the two groups.RESULTS The abdominal infection was the main infection among the 80 infection patients after duodenectomy.106 strains of pathogens were isolated,mainly gram-negative bacteria.Multivariate logistic regression analysis showed that operation time≥3 h(OR=2.195,P=0.004),intraoperative transfusion volume≥600 ml(OR=1.772,P=0.008),serum albumin 30 g/L(OR=2.438,P=0.004),pancreatic fistula(OR=2.385,P=0.003),biliary fistula(OR=2.085,P=0.006)and postoperative bleeding(OR=1.982,P=0.003)were independent risk factors for postoperative infection(P<0.05).The levels of CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)in the study group were significantly lower than those in the control group(P<0.05).The levels of serum TNF-α,IL-6 and IL-10 in the study group were higher than those in the control group,while IL-2 was significantly lower than that in the control group(P<0.05).CONCLUSION The occurrence of duodenectomy infection is closely related to a variety of factors,and the immune function and Th1/Th2 cell level of patients are abnormal.Clinical attention should be paid to these characteristics for prevention and treatment measures.