剖宫产产妇产褥期感染的危险因素及Th17/Treg细胞水平

Risk factors for puerperal infections in cesarean section puerpera and levels of Th17/Treg cells

目的分析导致剖宫产产妇发生产褥期感染的危险因素及Th17/Treg细胞水平变化,为预防产褥期感染提供依据。方法选取2019年1月-2023年1月于福建医科大学附属第二医院行剖宫产手术的780例产妇为研究对象,根据术后是否发生产褥期感染分为感染组34例、非感染组746例,分析感染病原菌分布特点,单因素及多因素Logistic回归分析感染危险因素,检测两组细胞因子降钙素原(PCT)、C-反应蛋白(CRP)和白细胞计数(WBC)水平及辅助性T细胞17(Th17)、调节性T细胞(Treg)百分率。结果780例剖宫产产妇发生产褥期感染的为34例,感染率为4.36%;共检出52株病原菌,其中革兰阴性菌37株占71.15%,革兰阳性菌15株占28.85%;多因素Logistic回归分析结果显示,胎膜早破、产后出血、产前白蛋白<35 g/L为剖宫产产妇产褥期感染的危险因素(OR=2.232、2.474、2.186,均P<0.001);感染组PCT、CRP、WBC水平及Th17百分率、Th17/Treg均高于非感染组,而Treg百分率低于非感染组(P<0.05)。结论剖宫产产妇发生产褥期感染的感染率较高,其感染病原菌主要为革兰阴性菌,危险因素包括胎膜早破、产后出血、产前白蛋白<35 g/L,Th17/Treg失衡对剖宫产产褥期感染具有明显影响。

OBJECTIVE To analyze the risk factors for puerperal infection in the puerpera and observe the change of levels of Th17/Treg cells so as to provide bases for prevention of puerperal infection.METHODS A total of 780 puerpera who underwent cesarean section in the Second Affiliated Hospital of Fujian Medical University from Jan 2019 to Jan 2023 were recruited as the research subjects and were divided into the infection group with 34 cases and the non-infection group with 746 cases according to the status of postoperative puerperal infection.The distri-bution of pathogens was observed,univariate analysis and multivariate logistic regression analysis were performed for the risk factor for the infection.The levels of cytokines procalcitonin(PCT),C-reactive protein(CRP)and white blood cell(WBC)as well as the percentages of type 17 helper T(Th17)and regulatory T(Treg)cells were detected for the two groups of subjects.RESULTS Of the 780 cesarean section puerpera,34 had puerperal infec-tion,with the infection rate 4.36%.Totally 52 strains of pathogens were isolated,37(71.15%)of which were gram-negative bacteria,and 15(28.85%)were gram-positive bacteria.The result of multivariate logistic regres-sion analysis showed that premature rupture of membranes,postpartum hemorrhage and prenatal albumin less than 35g/L were the risk factors for the puerperal infection in the cesarean section puerpera(OR=2.232,2.474,2.186,all P<0.001).The PCT,CRP and WBC levels,percentage of Th17 and Th17/Treg of the infection group were higher than those of the non-infection group,while the percentage of Treg of the infection group was lower than that of the non-infection group(P<0.05).CONCLUSION The incidence of puerperal infection is high among the cesarean section puerpera.The gram-negative bacteria are dominant among the pathogens causing the infec-tion.The risk factors include the premature rupture of membranes,postpartum hemorrhage and prenatal albumin less than 35 g/L.The imbalance of Th17/Treg has remarkable effect on the puerperal infection of the cesarean section puerpera.