胰腺炎合并感染患者血浆中性粒细胞胞外诱捕网水平及临床意义  

Variation level of plasma neutrophil extracellular traps in pancreatitis patients combined with infection and its clinical significance

作　　者：余雪[1] 丁春阳 陈炳勋[3] 李汉智[3] 黄普[4] YU Xue;DING Chun-yang;CHEN Bing-xun;LI Han-zhi;HUANG Pu(Nanyang Medical College Nanyang,Henan 473000,China;不详)

机构地区：[1]南阳医学高等专科学校国教院,河南南阳473000 [2]镇江市高等专科学校,江苏镇江212000 [3]南阳医学高等专科学校第一附属医院普外,河南南阳473000 [4]南阳医学高等专科学校第一附属医院消化内科,河南南阳473000

出　　处：《中华医院感染学杂志》2020年第23期3649-3654,共6页Chinese Journal of Nosocomiology

基　　金：南阳市科技攻关基金资助项目(KJGG153)。

摘　　要：目的探究胰腺炎合并感染患者血浆中性粒细胞胞外诱捕网(NETs)水平及其与病情严重程度、预后的关系。方法选择南阳医学高等专科学校第一附属医院2016年12月-2019年6月收治的202例急性胰腺炎合并细菌感染患者纳入感染组;另择同期收治的100例未并发感染的急性胰腺炎患者及50名查体的健康成年人,分别纳入急性胰腺炎组及对照组。检测感染患者病原菌,采用荧光光度法测定各组受试者血浆NETs水平,收集患者外周血白细胞计数、中性粒细胞、降钙素原(PCT)、C-反应蛋白(CRP)、急性生理学及慢性健康评分标准(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)等资料,随访统计感染组患者28 d死亡率。结果 202例胰腺炎合并感染患者标本共分离病原菌234株,其中革兰阴性菌株152株占64.96%,革兰阳性菌72株占30.77%,真菌10株占4.27%。感染组患者血浆NETs水平高于胰腺炎组及对照组(P<0.05),胰腺炎组NETs水平高于对照组(P<0.05);感染组患者白细胞计数、中性粒细胞比例、血清PCT、CRP水平及APACHEⅡ评分、SOFA评分均高于胰腺炎组(P<0.05)。血浆NETs水平、中性粒细胞比例及血清PCT水平与APACHEⅡ评分、SOFA评分呈正相关(P<0.05)。死亡组患者血浆NETs水平、白细胞计数、中性粒细胞比例、血清PCT、CRP水平及APACHEⅡ评分、SOFA评分均高于存活组(P<0.05)。ROC曲线示,血浆NETs水平、白细胞计数、中性粒细胞比例、血清PCT、CRP水平预测患者预后的曲线下面积分别为0.855、0.649、0.683、0.828、0.670。结论胰腺炎合并感染患者伴有血浆NETs水平的升高,NETs水平与患者病情严重程度及预后相关,临床可用于评估预后、指导治疗。OBJECTIVE To investigate the level of plasma neutrophil extracellular traps(NETs) in pancreatitis patients combined with infection and its relationship with the severity and prognosis of the disease. METHODS Total of 202 patients with acute pancreatitis and bacterial infection who were admitted to the the First Affiliated Hospital of Nanyang Medical College between Dec. 2016 and Jun. 2019 were recruited and divided into the infection group. Another 100 patients with acute pancreatitis and without infection were in the acute pancreatitis group, and 50 healthy adults were in the control group. Pathogenic bacteria in the infected patients were detected, and levels of plasma NETs in all groups were determined by fluorescence spectrophotometry. Data such as peripheral blood white blood cell count, neutrophils, procalcitonin(PCT), C-reactive protein(CRP), acute physiology, chronic health evaluation II(APACHEII) scores and sequential organ failure assessment(SOFA) scores were collected. Patients in the infection group were followed up and their 28-day mortality rates were statistically analyzed. RESULTS A total of 234 strains of pathogenic bacteria were isolated from 202 pancreatitis patients combined with infection, including 152 strains of Gram-negative bacteria(64.96%), 72 strains of Gram-positive bacteria(30.77%) and 10 strains of fungi(4.27%). The descending order of plasma NETs levels were the infection group, the pancreatitis group and the control group in turn(P<0.05). The levels of white blood cell count, the proportion of neutrophils, serum PCT and CRP, APACHEII score and SOFA score in the infection group were significantly higher than that in the pancreatitis group(P<0.05). Plasma NETs level, the proportion of neutrophils and serum PCT level were positively correlated with APACHEII score and SOFA score(P<0.05). Plasma NETs levels, white blood cell count, the proportion of neutrophils, serum PCT and CRP level, APACHEII score and SOFA score in the death group were significantly higher than that in the survival

关 键 词：胰腺炎 感染 中性粒细胞胞外诱捕网 预后 

分 类 号：R657.5+1[医药卫生—外科学]