检测血中细菌DNA预测术后早期感染的临床研究  

Clinical study on predictive value for postoperative infection by detection of microbial DNA.

作　　者：乔治[1] 黎沾良[1] 陆连荣[1] 吕艺[2] 于勇[2] 孙丹[2] 

机构地区：[1]中国人民解放军304医院普外科,北京100037 [2]中国人民解放军304医院中心研究室,北京100037

出　　处：《中国实用外科杂志》2004年第6期352-353,共2页Chinese Journal of Practical Surgery

摘　　要：目的　探讨腹部外科手术病人全血细菌DNA检测结果与血细菌培养、术后全身炎症反应综合征(SIRS)及感染的关系。方法　将 2 0 0 3年 5～ 10月收治的 6 3例腹部外科病人分为 :胃肠手术组和非胃肠手术组 ;大手术组和中等手术组 ;术后发生SIRS组和未发生SIRS组。术前和术后 2h、2 4h、4 8h采集外周血 ,利用聚合酶链反应 (PCR)技术进行细菌DNA检测。结果　术前PCR均为阴性 ,术后共有 12例PCR阳性。术后 2h、2 4h和4 8hPCR阳性率差异无显著性 (P >0 .0 5 )。胃肠和非胃肠手术组PCR阳性率分别为 2 0 .6 %和 17.2 %(P >0 0 5 )。大手术组和中手术组PCR阳性率分别为 36 .0 %和 7.9% (P <0 .0 1)。术后出现SIRS的病人PCR阳性率为 4 1.7% ,高于无SIRS组的 5 .1% (P <0 .0 1)。PCR阳性组SIRS发生率为 83.3% ,阴性组为 2 7.5 %(P <0 0 1)。PCR阳性者 6 6 6 7%发生感染并发症 ,阴性者无一发生 (P <0 .0 1)。术后血细菌培养阳性率 4 .8% ,显著低于PCR的 19.0 % (P <0 .0 1) ;培养阳性者 ,PCR均呈阳性。PCR阳性结果中大肠杆菌DNA阳性占6 6 7%。结论　腹部外科术后早期 (2h)即可发生肠道细菌易位 (BT) ,以大肠杆菌为主。BT与手术时间长 (>3h)和 (或 )失血量大 (>5 0 0mL)有关 ,而与是否胃肠手术无关。Objective To detect blood microbial DNA in patients receiving abdominal surgery, and compare the results with those of blood cultures, the incidence of systemic inflammatory response syndrome (SIRS) and postoperative infections. Methods Blood samples were collected before surgery, and on the 2nd, 24th, 48th hour after surgery for bacterial culture and microbial DNA detection. PCR was performed, with target for β-lactosidase gene of E. coli and 16S rRNA gene of most pathogenic bacteria. All patients were observed 30d for infectious complications. Results No bacterial DNA was detected before surgery, but it was positive in 12 patients (19.0%) postoperatively. The positive rate of PCR on the 2nd, 24th and 48th hour after surgery was 14.3%, 19.0% and 17.5% respectively (P>0.05). There were no differences in bacterial DNA detection between patients undergoing gastrointestinal(GI) or non-GI surgery (7/34 and 5/29 respectively). The percentage of bacterial DNA presence in patients undergoing major(duration>3h and/or blood loss>500mL) or moderate operations was 36.0% and 7.9% respectively (P<0.01). 83.3% PCR-positive patients manifested SIRS, but only 27.5% of PCR-negative patients did so (P<0.01). Two thirds of PCR-positive patients developed infectious complications, while none of PCR-negative patients did so (P<0.01). The blood culture was positive only in 3 patients (4.8%), all PCR-positive. Among the PCR positive results, E.coli DNA was found in 66.7%. Conclusion Intestinal bacterial translocation occurs in early stage after abdominal surgery, and is related to the duration of operations and blood loss, but not to whether GI tract is involved. Postoperative SIRS and infection have a close relationship with bacterial translocation, and the detection of microbial DNA by PCR might have predictive value for infectious complications after surgery.

关 键 词：术后感染 早期 肠道细菌易位 胃肠手术 细菌DNA 全身炎症反应综合征 全血检测 

分 类 号：R619.3[医药卫生—外科学]