肛肠疾病术后切口感染危险因素与肛周菌群及TLR4 mRNA对其预测价值

Risk factors for postoperative incisional infection in anorectal diseases and the predictive value of perianal flora and TLR4 mRNA

目的探讨肛肠疾病术后切口感染患者肛周菌群与Toll样受体4(TLR4)mRNA对术后切口感染的预测价值.方法选择2018年1月-2021年3月武汉市第八医院肛肠三科收治的241例行肛肠手术的住院患者作为研究对象,根据感染情况分为感染组38例及非感染组203例,于术前及术后1、3、7 d时测定TLR4 mRNA表达水平,于手术前后采用无菌棉拭子涂抹方法采集患者肛周样本,评估肛周菌群数量及种类情况.结果感染组手术时间长于非感染组(P<0.05);切口感染部位检出病原菌44株,其中革兰阴性菌30株占68.18%,革兰阳性菌12株占27.27%,真菌2株占4.55%;共46例发生肛周菌量变化,肛周菌量增加患者感染率高于肛周菌量无增加患者(P<0.05);共53例发生肛周菌种变化,肛周菌群增加患者感染率高于肛周菌群无增加患者(P<0.05);Logistic多因素分析显示,手术时间、肛周菌种、肛周菌量是肛肠疾病术后切口感染的危险因素(P<0.05);感染组及非感染组术后TLR4水平均升高(P<0.05),感染组术后3、7 d时TLR4水平高于非感染组(P<0.05);术后1、3、7 d TLR4预测术后切口感染的ROC曲线下面积(AUC)分别为0.682、0.854、0.805.结论肛肠疾病术后切口感染患者肛周菌群数量、种类及TLR4表达量明显增加,通过检测肛周菌群数量、早期动态监测TLR4的表达可一定程度上评估感染风险,为早期治疗及干预提供参考.

OBJECTIVE To investigate the predictive value of perianal flora and Toll-like receptor 4(TLR4)mRNA for postoperative incision infection in patients with anorectal diseases.METHODS A total of 241 inpatients who underwent anorectal operation in the Third Proctology Department of Wuhan Eighth Hospital from Jan.2o18 to Mar.2021 were selected as the study subjects and were divided into 38 cases of the infected group and 203 cases of the uninfected group according to the infection status.TLR4 mRNA expression levels were measured before operation and on day 1,day 3 and day 7 after operation,and perianal samples were collect by sterile cotton swab before and after operation to evaluate the number and species of perianal flora.RESULTS The duration of surgery was significantly longer in the infected group than in the non-infection group(P<o.05).A total of 44 pathogenic bacteria strains were detected at incision infection site,of which 30 strains of gram-negative bacteria accounted for 68.18%,12 strains of gram-positive bacteria accounted for 27.27%and 2 strains of fungi accounted for 4.55%.A total of 46 patients experienced changes in the number of perianal flora,and the infection rate was higher in patients with increased number of perianal flora than in patients without increased number of perianal flora(P<0.05).A total of 53 cases experienced changed in species of perianal flora,and the infection rate in patients with increased species of perianal flora was higher than in patients without increased species of perianal flora(P<0.05).Multivariate logistic analysis showed that duration of operation,increased species of perianal flora and increased number of perianal bacteria were risk factors for postoperative incisional infection in anal disease(P<0.05).TLR4 levels were elevated in both the infected group and the uninfected group postoperatively(P<0.05).TLR4 level in the infected group was significantly higher than that in the uninfected group on day 3 and day 7 after operation(P<0.05).The area under the ROC curve(AUC)of TLR4 levels on day 1,day 3 and day 7 after operation for predicting postoperative incision infection was 0.682,0.854 and 0.805,respectively.CONCLUSION The number and types of perianal flora and TLR4 expression level were increased in anorectal disease patients with postoperative incision infection.The detection of the number of perianal flora and early dynamic monitoring of TLR4 expression could assess the risk of infection to a certain extent,thereby providing a reference for early treatmentand intervention.