产妇产褥感染病原菌特点及白细胞介素-6、肿瘤坏死因子-α、α1酸性糖蛋白联合检测对感染程度的预测价值

Characteristics of the pathogenic bacteria of maternal puerperal infection and the predictive value of the combined detection of interleukin-6,tumor necrosis factor-α,andα1-acid glycoprotein on the degree of infection

目的 分析产妇产褥感染病原菌的特点及白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、α1酸性糖蛋白(α1-AG)联合检测对感染程度的预测价值。方法 选取2022年12月至2023年11月山东省泰安市妇幼保健院收治的62例产褥感染产妇为研究组,纳入同期65例无产褥感染产妇为对照组。采用全自动微生物鉴定仪检测病原菌,酶联免疫吸附法检测组间IL-6、TNF-α、α1-AG水平,影响因素行logistic回归分析,绘制受试者工作特征(ROC)曲线分析IL-6、TNF-α、α1-AG对不同产褥感染患者感染程度的预测价值。结果 62例产褥感染患者以宫内感染最为常见,占比41.94%,阴道感染(30.65%)占比第二;62例产褥感染患者共检出74株病原菌,其中革兰氏阴性菌占比63.51%,革兰氏阳性菌占比31.08%;革兰氏阴性菌中以大肠埃希菌、铜绿假单胞菌最为常见,分别占比39.19%、17.57%,革兰氏阳性菌中金黄色葡萄球菌最为常见,占比17.57%。研究组IL-6、TNF-α、α1-AG水平均高于对照组(P<0.05);研究组产褥期重度感染患者IL-6、TNF-α、α1-AG水平高于轻度感染组与中度感染组(P<0.05)。IL-6、TNF-α、α1-AG高水平表达为产褥感染不同感染程度的独立危险因素(P<0.05)。ROC曲线结果显示,IL-6、TNF-α、α1-AG三项联合检测的灵敏度为96.77%,特异度为96.92%,均高于单一指标检测结果;三项联合检测的曲线下面积为0.901(95%CI=0.813~0.950)。结论 产褥感染主要发生于宫内感染,病原菌以革兰氏阴性菌为主,IL-6、TNF-α、α1-AG联合检测在产褥不同感染程度患者中的预测价值较高。

Objective To analyze the characteristics of the pathogenic bacteria of maternal puerperal infection and the predictive value of the combined detection of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),andα1-acid glycoprotein(α1-AG)on the degree of infection.Methods A total of 62 pregnant women with puerperal infection treated in Taian Maternal and Child Health Hospital of Shandong Province from December 2022 to November 2023 were selected as the study group,and 65 pregnant women without puerperal infection were included as the control group.Automatic microbial identification instrument was used to detect pathogenic bacteria,enzyme linked immunosorbent assay was used to detect the levels of IL-6,TNF-α,andα1-AG between the groups,and the influencing factors were analyzed by logistic regression,receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of IL-6,TNF-α,andα1-AG on the infection degree of patients with different puerperal infection.Results Among the 62 patients with puerperal infection,intrauterine infection was the most common,accounting for 41.94%,followed by vaginal infection(30.65%).A total of 74 strains of pathogenic bacteria were detected in 62 patients with puerperal infection,of which 63.51%were Gram-negative bacteria and 31.08%were Gram-positive bacteria.Among Gram-negative bacteria,Escherichia coli and Pseudomonas aeruginosa were the most common,accounting for 39.19%and 17.57%,respectively.Among Gram-positive bacteria,Staphylococcus aureus was the most common,accounting for 17.57%.The levels of IL-6,TNF-α,andα1-AG in the study group were higher than those in the control group(P<0.05).The levels of IL-6,TNF-α,andα1-AG in severe puerperal infection group were higher than those in mild infection group and moderate infection group(P<0.05).The high levels of IL-6,TNF-α,andα1-AG were independent risk factors for different levels of puerperal infection(P<0.05).ROC curve results showed that the sensitivity and specificity of IL-6,TNF-α,andα1-AG combined detection were 96.77%and 96.92%,which were higher than the results of single detection.The area under curve of combined detection was 0.901(95%CI=0.813-0.950).Conclusion Puerperal infection mainly occurs in intrauterine infection,and the main pathogens are mainly Gram-negative bacteria.The combined detection of IL-6,TNF-α,andα1-AG has high predictive value in patients with different degree of puerperal infection.