慢性肾衰竭血液透析患者医院感染病原学及Th22和IL-22的诊断价值

Etiological characteristics of nosocomial infection in chronic renal failure patients undergoing hemodialysis and diagnostic values of Th22 and IL-22

目的分析慢性肾衰竭(CRF)血液透析患者医院感染病原学特点及辅助性T细胞22(Th22)和白细胞介素-22(IL-22)的诊断价值,为临床提供诊断依据.方法选取2018年2月-2020年2月郑州市第七人民医院收治的82例行血液透析治疗的CRF患者,根据有无发生医院感染分为感染组(n=32)和未感染组(n=50),分析感染病原学特点,采用受试者工作特征(ROC)曲线评估外周血Th22细胞、IL-22水平诊断CRF血液透析患者并发医院感染的价值.结果32例行血液透析CRF患者医院感染类型主要为呼吸系统感染,占43.75%;共培养出病原菌56株,主要以革兰阴性菌为主,占62.50%;感染组外周血Th22细胞及IL-22水平高于未感染组(P<0.05),且随感染程度的加重而升高(P<0.05);ROC曲线分析显示,外周血Th22细胞和IL-22水平联合诊断CRF血液透析患者并发医院感染的曲线下面积(AUC)为0.848,敏感度和特异度分别为94.00%,60.00%.结论CRF血液透析患者并发医院感染的病原菌以革兰阴性菌为主,外周血Th22细胞、IL-22水平呈高表达,且与医院感染病情程度有关.

OBJECTIVE To analyze the etiological characteristics of nosocomial infection in the chronic renal failure(CRF)patients undergoing hemodialysis and explore the diagnostic values of helper T cell 22(Th22)and interleukin-22(IL-22)so as to provide guidance for clinical diagnosis.METHODS A total of 82 patients with CRF who underwent hemodialysis in the 7th People's Hospital of Zhengzhou from Feb 2018 to Feb 2020 were enrolled in the study and were divided into the infection group with 32 cases and the no infection group with 50 cases according to the status of nosocomial infection.The etiological characteristics of infection were analyzed.The values of the peripheral blood Th22 cell and IL-22 in diagnosis of nosocomial infection were evaluated by means of receiver operating characteristic(ROC)curves.RESULTS The patients who had respiratory system infection were dominant among the 32 CRF patients with nosocomial infection,accounting for 43.75%.Totally 56 strains of pathogens were isolated,62.50%of which were gram-negative bacteria.The levels of peripheral blood Th22 cell and IL-22 of the infection group were higher than those of the no infection group(P<0.O5),and the levels of the above indexes were elevated with the aggravation of the infection(P<0.05).ROC curve analysis showed that the area under curve(AUC)of the joint detection of peripheral blood Th22 cell and IL-22 was O.848 in diagnosis of the noso-comial infection in the CRF patients undergoing hemodialysis,with the sensitivity 94.00%,the specificity 60.00%.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the CRF hemodialysis patients complicated with nosocomial infection.The patients show high expression levels of peripheral blood Th22 cell and IL-22,which is associated with the severity of nosocomial infection.