重症急性胰腺炎继发脓毒症与肠道细菌易位、炎症及免疫抑制的关系  

Relationship between bacterial translocation,inflammation,and immunosuppression and sepsis secondary to severe acute pancreatitis

作　　者：朱云祥[1] 韩波 李昊晋 许尚峥 巨森 ZHU Yun-xiang;HAN Bo;LI Hao-jin;XU Shang-zheng;JU Sen(Intensive Care, Guangyuan Central Hospital, Sichuan, Guangyuan 628000, China;Intensive Care, Third People＇s Hospital of Guangyuan City, Sichuan, Guangyuan 628000, China)

机构地区：[1]广元市中心医院重症医学科,四川广元628000 [2]广元市第三人民医院重症医学科

出　　处：《中国病原生物学杂志》2017年第10期1010-1013,共4页Journal of Pathogen Biology

摘　　要：目的探讨重症急性胰腺炎(SAP)脓毒症的发生与肠道细菌易位、炎症及免疫抑制的关系。方法 2012年3月-2016年10月本院重症医学科收治的SAP患者160例,按脓毒症诊断标准分为脓毒症组(63例)和非脓毒症组(97例)。采集患者胰腺周围渗液进行细菌培养,同时留取尿液及血液标本用于肠粘膜通透性、炎症及免疫相关指标的检测。结果 160例SAP患者胰腺周围渗液中共分离出225株细菌,主要为革兰阴性菌(81.78%),包括大肠埃希菌、铜绿假单胞杆菌、产气杆菌、肺炎克雷伯菌,革兰阳性菌(18.22%)包括金黄色葡萄球菌、表皮葡萄球菌和肠球菌,脓毒症和非脓毒症组细菌构成基本一致;脓毒症组患者血清内毒素(ET)[(0.62±0.06)EU/ml]、肿瘤坏死因子α(TNF-α)[(4.44±0.07)g/L]、白细胞介素1β(IL-1β)[(1.86±0.22)μg/L、IL-6(239.40±38.93)]、IL-8[(0.55±0.12)μg/L]水平,乳果糖与甘露醇排泄率比值(L/M)(0.54±0.08)以及外周血调节性T细胞(Treg)水平[(10.64±1.50)%]均显著高于非脓毒症组(P<0.05),T辅助淋巴细胞1/2(Th1/Th2)值(0.84±0.34)低于非脓毒症组(P<0.05)。结论 SAP脓毒症的发生与肠源性细菌易位、炎症因子的过度释放及免疫抑制等因素所导致的肠屏障功能受损密切相关。Objective To investigate the relationship between bacterial translocation,inflammation,and immunosuppression and sepsis secondary to severe acute pancreatitis（SAP）. Methods Subjects were 160 patients with SAP who were treated in the intensive care unit（ICU）of this Hospital from March 2012 to October 2016.Patients were divided into those with sepsis（n=63）and those without sepsis（n=97）according to diagnostic criteria for sepsis.Peripancreatic fluid was collected from all of the patients for bacterial culture.Urine samples and blood samples were collected to detect mucosal permeability and inflammation and to determine immune-related indexes. Results Two hundred and twentyfive strains of bacteria were isolated from the peripancreatic fluid from 160 patients with SAP.Most of the bacteria were Gram-negative（81.78%）,including Escherichia coli,Pseudomonas aeruginosa,Bacillus gasoformans,and Klebsiella pneumoniae.Gram-positive bacteria（18.22%）included Staphylococcus aureus,Staphylococcus epidermidis,and Enterococcus.The composition of bacteria in patients with and without sepsis was basically the same.Compared to patients without sepsis,patients with sepsis had significantly higher（P〈0.05）levels of serum endotoxin（ET）[0.62±0.06 EU/ml],tumor necrosis factorα（TNF-α）[4.44±0.07 g/L],interleukin 1β（IL-1β）[1.86±0.22μg/L],IL-6[239.40±38.93],and IL-8[0.55±0.12μg/L].Patients with sepsis had a significantly higher ratio of lactulose and mannitol excretion（L/M）（0.54±0.08）（P〈0.05）as well as a significantly higher percentage of regulatory T cells（Treg）[（10.64±1.50）%]in peripheral blood（P〈0.05）.However,patients with sepsis had a significantly lower ratio of type 1 and 2 T helper cells（Th1/Th2）（0.84±0.34）than that in patients without sepsis（P〈0.05）. Conclusion The development of sepsis secondary to SAP is closely related to impairment of the intestinal barrier by intestinal bacterial translocation,excessive release of inflammatory factors,

关 键 词：重症急性胰腺炎 脓毒症 细菌易位 炎症 免疫抑制 

分 类 号：R378[医药卫生—病原生物学]