初产妇会阴侧切伤口感染病原菌分布、Th1/Th2细胞因子及感染因素分析  

Analysis of the distribution of pathogens,Th1/Th2 cytokine levels,and high-risk factors for infection of an episiotomy incision in primiparas

作　　者：陈秋霞 汪洪林 张林静 黄赞怡 赵振东 CHEN Qiu-xia;WANG Hong-lin;ZHANG Lin-jing;HUANG Zan-yi;ZHAO Zhen-dong(Department of Gynaecology and Obstetrics,Hainan Women and Children y s Medical Center,Haikou 570106,Hainan,China;Department of Obstetrics,Hainan Women and Children's Medical Center,Haikou 570106,Hainan,China;Department of Laboratory,Hainan Women and Children's Medical Center,Haikou 570106,Hainan,China)

机构地区：[1]海南省妇女儿童医学中心妇产科,海南海口570206 [2]海南省妇女儿童医学中心产科,海南海口570206 [3]海南省妇女儿童医学中心检验科,海南海口570206

出　　处：《中国病原生物学杂志》2021年第6期705-709,共5页Journal of Pathogen Biology

摘　　要：目的检测初产妇会阴侧切伤口感染病原菌分布及Th1/Th2细胞因子水平,并分析感染危险因素。方法 2018年7月-2020年7月于海南省妇女儿童医学中心行会阴侧切术的阴道分娩初产妇152例,根据是否发生会阴侧切伤口感染分为感染组(18例)和未感染组(134例)。采集感染组患者伤口分泌物进行细菌的分离培养及鉴定;采集产妇外周血,采用ELISA法检测Th1/Th2细胞及其相关细胞因子水平;收集产妇相关临床资料进行单因素分析和Logistic回归分析以明确伤口感染危险因素。结果 152例初产妇患者中发生会阴侧切伤口感染18例,感染率为11.84%;共检出病原菌24株,以革兰阴性菌为主,占58.33%。与未感染组比较,感染组初产妇外周血Th1和Th2细胞比例以及IFN-γ和IL-4水平显著增高,Th1/Th2及IFN-γ/IL-4比值显著降低(均P<0.05)。单因素分析显示,≥30岁、BMI≥28.0 kg/m2、急诊分娩、产钳助产和臀部助产、阴道指检次数≥3次、切口长度≥3 cm、产程≥16初产妇会阴侧切伤口感染率较高,以浅表感染多见,感染病原菌以革兰阴性菌为主。感染者存在Th1/Th2细胞平衡紊乱,BMI、阴道指检次数、切口长度、产程、妊娠期糖尿病、胎膜早破、产后出血、生殖道感染、羊水污染等为感染发生危险因素,可为切口感染的预防和治疗提供参考。Objective To detect the distribution of pathogens and Th1/Th2 cytokines in primiparas with infection of an episiotomy incision and to analyze the risk factors for infection. Methods Subjects were 152 primiparas who underwent a lateral episiotomy during vaginal delivery at the Hainan Women and Children’s Medical Center from July 2018 to July 2020. Subjects were divided into primiparas with infection of an episiotomy incision(18 patients) and primiparas without an infection(134 patients) depending on whether a surgical site infection developed after a lateral episiotomy. The patient’s age, gestational weeks, height, weight, emergency delivery, mode of delivery, season of delivery, the number of digital vaginal examinations, incision length, the duration of labor, whether the patient had gestational diabetes, a birth canal laceration, a reproductive tract infection, premature rupture of membranes, a postpartum hemorrhage, or amniotic fluid contamination and other data were collected. The ratio of Th1 and Th2 cells was detected using flow cytometry, and the ratio of Th1/Th2 cells was calculated. Venous blood was collected from primiparas, serum was separated, and levels of γ-Interferon-γ, IFN-γ, and interleukin-4(IL-4) were determined using ELISA. Infection status, pathogen distribution, levels of Th1-and Th2-related cytokines, and levels of Th1/Th2 cells in primiparas with an episiotomy incision infection were analyzed. Univariate analysis and logistic regression analysis were used to identify the risk factors for a surgical site infection. Results Of 152 primiparas who underwent a lateral episiotomy, 18 had a surgical site infection, for a rate of infection of 11.84%. A total of 24 strains of pathogens were detected. Strains were mainly Gram-negative bacteria(58.33%). In primiparas with infection of an episiotomy incision, the Th1(14.98±2.36) and Th2 cell ratio(7.79±1.48) and levels of IFN-γ(32.45±3.21) and IL-4(23.93±2.48) were significantly higher than those in primiparas without an infection(Th2: 8.1

关 键 词：会阴侧切术 切口感染 初产妇 病原菌 TH1/TH2细胞 危险因素 

分 类 号：R378[医药卫生—病原生物学]