重症急性胰腺炎患者人类白细胞抗原DR位点表达与多药耐药菌感染间的关系分析  

Association between expression of human leukocyte antigen DR site and multidrug-resistant organisms infections in patients with severe acute pancreatitis

作　　者：周芸[1] 丁群力[2] 甘永雄 张筠[2] ZHOU Yun;DING Qun-li;GAN Yong-xiong;ZHANGYun(Affiliated Hospital of Medical School,Ningbo University,Ningbo,Zhejiang 315020,China)

机构地区：[1]宁波大学医学院附属医院急诊科,浙江宁波315020 [2]宁波大学医学院附属医院呼吸与危重症医学科,浙江宁波315020

出　　处：《中华医院感染学杂志》2020年第13期1981-1985,共5页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(LY15H010004)。

摘　　要：目的探究重症急性胰腺炎(SAP)患者人类白细胞抗原DR位点(HLA-DR)表达与多药耐药菌(MDR)感染间的关系。方法选择2016年1月-2019年3月于宁波大学医学院附属医院确诊的SAP患者96例作为研究对象,根据患者住院期间是否继发感染以及感染的病原菌耐药性将患者分为非感染组、非MDR感染组以及MDR感染组。比较三组患者入院后第1天、第7天、第14天以及第28天外周静脉血CD4+/CD8+细胞比、自然杀伤(NK)细胞百分比以及HLA-DR百分比间的差异。采用Logistic多元回归探究影响MDR感染的独立相关因素。结果MDR组患者外周血单核细胞HLA-DR的表达量在患者入院后的第1天、第7天、第14天以及第28天均低于非感染组以及非MDR感染组患者(P<0.05)。APACHEⅡ评分以及入院后第1天HLA-DR表达水平是影响MDR感染发生的独立相关因素。结论SAP患者外周血单核细胞HLA-DR表达水平降低与MDR感染间存在显著的相关性。OBJECTIVE To explore the correlation between the expression of human leukocyte antigen DR site(HLA-DR)and multidrug-resistant organisms(MDROs)infections.METHODS A total of 96 patients who were diagnosed with severe acute pancreatitis(SAP)in Affiliated Hospital of Medical College of Ningbo University from Jan 2016 to Mar 2019 were recruited as the study objects and divided into the non-infection group,the non-MDR infection group and the MDR infection group according to the status of secondary infection during the hospital stay and the drug resistance of the pathogens causing infection.The peripheral blood CD4+to CD8+ratio,percentage of natural killer(NK)cells and percentage of HLA-DR were observed and compared among the 3 groups of patients after the admission for 1,7,14 and 28 days.Multivariate logistic regression analysis was performed for the influencing factors for the MDROs infections.RESULTS The expression of HLA-DR in peripheral blood mononuclear cells was significantly lower in the MDR group than in the non-infection group and the non-MDR group after the admission for 1,7,14 and 28 days.APACHEⅡscore and expression of HLA-DR on Day 1 of admission were the independent influencing factors for the MDROs infection.CONCLUSION The decline of expression of HLA-DR in peripheral blood mononuclear cells shows remarkable association with the MDROs infections in the patients with SAP.

关 键 词：胰腺炎 多药耐药菌 人类白细胞抗原DR位点 败血症 

分 类 号：R576[医药卫生—消化系统]