剖宫产后产褥期感染病原菌及Th17/Treg细胞因子对感染的预测价值

Pathogens from cesarean section puerpera with puerperal infection and value of Th17/Treg cytokines in prediction of infection

目的分析剖宫产后产褥期感染病原菌,并探究辅助性T细胞17/调节性T细胞(Th17/Treg)对感染的预测价值。方法选取2020年1月-2022年4月于东阳市人民医院行剖宫产手术的388例产妇为研究对象,依据产后是否发生产褥期感染分为感染组18例和未感染组370例,检测产褥期感染病原菌,分析两组外周血Th17/Treg水平,以受试者工作特征(ROC)曲线评估Th17/Treg对感染的预测价值。结果18例感染患者共检出病原菌25株,革兰阴性菌18株,占比72.00%,以大肠埃希菌、阴道加德纳菌为主;革兰阳性菌7株,占比28.00%,以溶血性链球菌、粪肠球菌为主。感染组外周血Th17/Treg水平高于未感染组(P<0.05)。ROC曲线分析结果显示,Th17/Treg水平评估产褥期感染的曲线下面积(AUC)为0.890,灵敏度及特异性分别为88.89%、83.51%,均高于Th17、Treg单独评估(P<0.05)。结论剖宫产后产褥期感染的病原菌以大肠埃希菌、阴道加德纳菌等革兰阴性菌为主;Th17/Treg水平与剖宫产产妇产褥期感染密切相关,临床可通过早期监测Th17/Treg水平实现对剖宫产产妇产褥期感染的早期预测。

OBJECTIVE To investigate the pathogens isolated from cesarean section puerpera with puerperal infection and explore the value of helper T cell 17/regulatory T cell(Th17/Treg)in prediction of the infection.METHODS A total of 388puerpera who underwent cesarean section in the Dongyang People′s Hospital from Jan 2020to Apr 2022were recruited as the research subjects and were divided into the infection group with 18cases and the no infection group with 370cases according to the status of puerperal infection.The pathogens isolated from the subjects with puerperal infection were identified,the level of peripheral blood Th17/Treg was observed and compared between the two groups,and the value of Th17/Treg in prediction of the infection was evaluated by receiver operating characteristic(ROC)curves.RESULTS Totally 25strains of pathogens were isolated from the 18patients with infection,18(72.00%)of which were gram-negative bacteria,and 7(28.00%)were gram-positive bacteria;Escherichia coli and Gardner′s vaginalis were the predominant species of the gram-negative bacteria;Streptococcus hemolyticus and Enterococcus faecalis were dominant among the gram-positive bacteria.The peripheral blood Th17/Treg level of the infection group was significantly higher than that of the no infection group(P<0.05).ROC curve analysis showed that the area under curve(AUC)of the Th17/Treg was 0.890in assessment of puerperal infection,with the sensitivity 88.89%,the specificity 83.51%,significantly higher than those of the single index Th17and Treg(P<0.05).CONCLUSION Among the pathogens isolated from the cesarean section pregnant women with puerperal infection,E.coli and G.vaginalis are the predominant species of gram-negative bacteria.The Th17/Treg level is closely associated with the puerperal infection.It is necessary for the hospital to conduct the early monitoring of Th17/Treg level so as to achieve the early prediction of puerperal infection in the cesarean section pregnant women.