老年糖尿病患者口腔颌面部感染病原菌特点及Th17/Treg细胞免疫变化  

Etiological characteristics of oral and maxillofacial infections and change of Th17/Treg cellular immunity of elderly patients with diabetes mellitus

作　　者：韩琴 黄祥妹 陈玉玲 徐爱红 陈兴强 HAN Qin;HUANG Xiang-mei;CHEN Yu-ling;XU Ai-hong;CHEN Xing-qiang(Saniya Peopled Hospital^Sanya Hainan 572000,China;不详)

机构地区：[1]三亚市人民医院老年病科,海南亚572000 [2]海南医学院第一附属医院内镜诊疗室,海南海口570102 [3]三亚市人民医院供应室,海南亚572000 [4]三亚市人民医院肾内科,海南亚572000

出　　处：《中华医院感染学杂志》2021年第1期15-18,共4页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(819MS123)。

摘　　要：目的探讨老年糖尿病患者口腔颌面部间隙感染(oral and maxillofacial space infection,OMSI)病原学特点及辅助性T细胞17(Th17)/调节性T细胞(Treg)细胞免疫的变化。方法选择三亚市人民医院老年科2017年1月-2019年3月收治的老年糖尿病患者142例作为研究对象,根据患者是否发生OMSI分为感染组82例及非感染组60例。分析感染患者病原菌分布及耐药性,分别采用流式细胞术及酶联免疫吸附法检测两组患者外周血中Th17/Treg及白细胞介素-17(IL-17)、白细胞介素-23(IL-23)、干扰素-γ(IFN-γ)和转化生长因子-β(TGF-β)水平。结果感染患者临床标本共检出病原菌87株,其中革兰阳性菌57株,占65.52%,革兰阴性菌30株,占34.48%;检出的主要革兰阳性菌对头孢曲松、头孢噻肟、头孢唑林和氨苄西林耐药率较高;检出的主要革兰阴性菌对左氧氟沙星、环丙沙星、庆大霉素耐药率较高;感染组Th17(17.52±2.18)%、Th17/Treg(3.01±0.24)、IL-17(65.67±18.24)pg/ml、IL-23(42.08±11.39)pg/ml均高于对照组(均P<0.05),Treg(5.83±1.06)%、IFN-γ(18.89±5.22)pg/ml、TGF-β水平(23.24±6.01)pg/ml均低于对照组(P<0.05)。结论老年糖尿病患者口腔颌面部间隙感染病原菌以金黄色葡萄球菌、表皮葡萄球菌、溶血链球菌、普雷沃氏菌和肺炎克雷伯菌检出率较高,可根据耐药性选用合理抗菌药物,感染患者Th17/Treg失衡,Th17细胞及促炎细胞因子表达升高,Treg细胞及抑炎细胞因子表达降低。OBJECTIVE To explore the etiological characteristics of oral and maxillofacial space infection(OMSI)and the change of helper T cell 17(Th17)/regulatory T cell(Treg)cellular immunity of the elderly patients with diabetes mellitus.METHODS A total of 142 elderly patients with diabetes mellitus who were treated in geriatric department of Sanya People′s Hospital from Jan 2017 to Mar 2019 were enrolled in the study and divided into the infection group with 82 cases and the non-infection group with 60 cases according to the status of OMSI.The distribution and drug resistance of pathogens were observed,and the levels of peripheral blood Th17/Treg,interleukin-17(IL-17),interleukin-23(IL-23),interferon-γ(IFN-γ)and transforming growth factor-β(TGF-β)were detected respectively using flow cytometry and enzyme-linked immunosorbent assay.RESULTS Totally,87 strains of pathogens were isolated from clinical specimens of the patients with infection,57(65.52%)of which were gram-positive bacteria,30(34.48%)were gram-negative bacteria.The drug resistance rates of the main gram-positive bacteria to ceftriaxone,cefotaxime,cefazolin and ampicillin were high;the drug resistance rates of the main gram-negative bacteria to levofloxacin,ciprofloxacin and gentamicin were high.The levels of Th17,Th17/TregIL-17 and IL-23 of the infection group were respectively(17.52±2.18)%,(3.01±0.24),(65.67±18.24)pg/ml and(42.08±11.39)pg/ml,significantly higher than those of the control group(all P<0.05);the levels of Treg,IFN-γand TGF-βof the infection group were respectively(5.83±1.06)%,(18.89±5.22)pg/ml and(23.24±6.01)pg/ml,significantly lower than those of the control group(P<0.05).CONCLUSION Staphylococcus aureus,Staphylococcus epidermidis,Streptococcus hemolyticus,Prevotella pneumoniae and Klebsiella pneumoniae are the predominant species of pathogens isolated from the elderly diabetes mellitus patients with OMSI.It is necessary to reasonably use antibiotics based on the drug resistance.The patients with infection have imbalance of Th17/T

关 键 词：糖尿病 口腔颌面部感染 耐药特征 辅助型T细胞17 调节型T细胞 

分 类 号：R587.2[医药卫生—内分泌]