胆囊结石并急性胆囊炎患者术后切口感染相关危险因素及其与Th1/Th2细胞因子水平的关联

Risk factors related to postoperative incision infection in patients with gallstones and acute cholecystitis and their association with Th1/Th2 cytokine levels

目的探讨胆囊结石伴急性胆囊炎手术切口感染的危险因素,分析感染与外周血T淋巴细胞亚群及Th1/Th2相关细胞因子水平的关系。方法选取2021年6月-2023年6月成都长江医院收治的实施胆囊结石伴急性胆囊炎手术患者260例作为研究对象,根据其术后是否出现切口感染分为感染组(n=27)和未感染组(n=233)。从医院电子病历系统中回顾性收集胆囊结石伴急性胆囊炎手术患者术前临床信息,分析导致术后切口感染的危险因素;对比两组患者术后24 h内T淋巴亚群比值及Th1/Th2相关细胞因子[白细胞介素-2(IL⁃2)、γ-干扰素(IFN⁃γ)、IL⁃4、IL⁃10]水平变化。结果年龄≥60岁、手术时间>60 min、合并糖尿病、转为开腹手术、术前未使用抗生素为胆囊结石伴急性胆囊炎手术切口感染的独立危险因素(P均<0.05)。感染组患者CD4^(+)/CD8^(+)和CD4^(+)/CD25^(+)、IL⁃2、IFN⁃γ水平低于未感染组,IL⁃4、IL⁃10水平高于未感染组,差异均有统计学意义(t=5.866、34.572、9.643、10.991、7.726、8.910,P均<0.05)。结论胆囊结石伴急性胆囊炎手术切口感染危险因素较多,临床可采取针对性干预措施降低感染发生率,且感染患者术后存在Th细胞亚群失衡及细胞因子紊乱。

Objective To explore the risk factors for surgical incision infection in patients with gallstones and acute cholecystitis,and analyze the relationship between infection and peripheral blood T lymphocyte subsets and Th1/Th2 related cytokine levels.Methods A total of 260 patients with acute cholecystitis in Chengdu Changjiang Hospital from June 2021 to June 2023 were selected as study subjects,and they were divided into infected group(n=27)group and uninfected group(n=233)according to whether the incision infection occurred.Risk factors for postoperative incision infection were retrospective analyzed from the collection of preoperative clinical information from surgery for gallstones with acute cholecystitis patients in the hospital electronic medical record system.The changes in T lymphocyte subsets ratio and Th1/Th2 related cytokine[interleukin⁃2(IL⁃2),interferon⁃γ(IFN⁃γ),IL⁃4,IL⁃10]levels within 24 hours after surgery between two groups of patients were compared.Results The independent risk factors of surgical incision infection of cholecystolithiasis with acute cholecystitis were age≥60 years,operation time>60 min,diabetes,conversion to laparotomy,and no use of antibiotics before operation(all P<0.05).The levels of CD4^(+)/CD8^(+)and CD4^(+)/CD25^(+)in the infected group were lower than those in the uninfected group(P<0.05);IL⁃2 and IFN⁃γlevels in infected patients were lower than those of the uninfected group(P<0.05);the levels of IL⁃4 and IL⁃10 were higher than those of the uninfected group(t=5.866,34.572,9.643,10.991,7.726,8.910;all P<0.05).Conclusions There were many risk factors for surgical incision infection in patients with gallstones and acute cholecystitis.Targeted intervention measures could be taken clinically to reduce the incidence of infection,and infected patients might have Th cell subsets imbalance and cytokine imbalance after surgery.