急诊科不同严重程度尿源性脓毒症患者免疫水平与病原菌群分布特点的分析  

Analysis of immune level and dis tribution characteristics of pathogenic bacteria in patients with urinary s epsis of different severity in emergency department

作　　者：陈丹 钟坚 李少洪[1] 吴燕妮 张磊云 CHEN Dan;ZHONG Jian;LI Shaohong;WU Yanni;ZHANG Leiyun(Department of Emergency Medicine,Dongguan Donghua Hospital,Dongguan Gu angdong 523110)

机构地区：[1]东莞东华医院急诊医学科,广东东莞523110

出　　处：《当代医药论丛》2022年第19期69-72,共4页

基　　金：东莞市社会科技发展重点项目(2018507150461630)。

摘　　要：目的:探究急诊科不同严重程度尿源性脓毒症患者的免疫水平与病原菌群分布的特点。方法:选择东莞东华医院急诊医学科收治的150例尿源性脓毒症患者,根据病情的严重程度将其分为脓毒症组(50例)、严重组(50例)和休克组(50例),对三组患者进行病原菌分析,检测其T淋巴细胞亚群的比例。结果:三组的各项血生化指标相比,差异有统计学意义(P<0.05)。随着病情严重程度的增加,肌酐、C反应蛋白的水平、白细胞计数、SOFA评分会逐渐升高,血小板计数会逐渐降低。进行流式细胞检测的结果显示,三组CD3^(+)、CD3^(+)和CD4^(+)、CD3^(+)和CD8^(+)、Treg的占比、Th/Ts相比,差异有统计学意义(P<0.05)。随着病情严重程度的增加,CD3^(+)、CD3^(+)和CD4^(+)、CD3^(+)和CD8^(+)、Treg的占比、Th/Ts会逐渐降低。脓毒症组中病原菌为革兰氏阴性菌的患者有30例,为革兰氏阳性菌的患者有20例。严重组中病原菌为革兰氏阴性菌的患者有35例,为革兰氏阳性菌的患者有15例。休克组中病原菌为革兰氏阴性菌的患者有40例,为革兰氏阳性菌的患者有10例。三组的病原菌分布情况相比,差异有统计学意义(P<0.05)。各组患者感染的革兰氏阴性菌以大肠埃希菌为主,革兰氏阳性菌以屎肠球菌为主。结论:病情严重的尿源性脓毒症患者容易出现肾功能障碍、凝血系统功能障碍、T淋巴细胞功能衰退,其病原菌以革兰氏阴性菌为主。Objective:To explore the characteristics of immune level and pathogen distribution in patients with urogenic sepsis of different severity in the emergency department.Methods:A total of 150 patients with urine-derived sepsis admitted to the Emergency Department of Dongguan Donghua Hospital were selected and divided into sepsis group(50 cases),severe group(50 cases)and shock group(50 cases)according to the severity of the disease.Pathogen analysis was performed in the three groups,and the proportion of T lymphocyte subsets was detected.Results:There were significant differences in blood biochemical indexes among the three groups(P<0.05).With the increase of the severity of the disease,the levels of creatinine,C-reactive protein,white blood cell count,SOFA score will gradually increase,and the platelet count will gradually decrease.The results of flow cytometry showed that there were statistically significant differences in the proportion of CD3^(+),CD3^(+)and CD4^(+),CD3^(+)and CD8^(+),Treg and Th/Ts among the three groups(P<0.05).With the increase of disease severity,the proportion of CD3^(+),CD3^(+)and CD4^(+),CD3^(+)and CD8^(+),Treg and Th/Ts would gradually decrease.In the sepsis group,30 patients had Gram-negative bacteria and 20 patients had Gram-positive bacteria.In the severe group,35 patients had Gram-negative bacteria and 15 patients had GRAM-positive bacteria.In the shock group,the pathogen was Gram-negative in 40 patients and Gram-positive in 10 patients.There were statistically significant differences in the distribution of pathogens among the three groups(P<0.05).The main gram-negative bacteria in each group were Escherichia coli and the main Gram-positive bacteria were Enterococcus faecium.Conclusion:Patients with severe urine-derived sepsis are prone to renal dysfunction,coagulation system dysfunction and T lymphocyte function decline,and Gram-negativ e bacteria are the main pathogens.

关 键 词：急诊科 尿源性脓毒症 免疫 病原菌群分布 

分 类 号：R631[医药卫生—外科学]