阑尾炎穿孔术后切口感染患儿外周血单核细胞表面HLA-DR/CD14水平及其诊断价值  

HLA-DR/CD14 on surface of peripheral blood mononuclear cells in children with incision infection after appendicitis perforation surgery and their diagnostic value

作　　者：裘宇辉 吴臻斐 章捷 冯召广 苏凯 QIU Yu-hui;WU Zhen-fei;ZHANG Jie;FENG Zhao-guang;SU Kai(Hangzhou Children's Hospital,Hangzhou,Zhejiang 310000,China)

机构地区：[1]杭州市儿童医院普外科,浙江杭州310000

出　　处：《中华医院感染学杂志》2023年第4期628-632,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2020KY231)。

摘　　要：目的 探讨阑尾炎穿孔术后切口感染患儿外周血单核细胞(PBMC)人类白细胞抗原DR(HLA-DR)/CD14及其诊断价值.方法 选取2016年1月-2020年12月杭州市儿童医院行腹腔镜术治疗术后切口感染阑尾炎穿孔患儿38例(感染组)和同期采取相同术式治疗术后无感染的阑尾炎穿孔患儿114例(无感染组)为研究对象,分析切口感染微生物特征,流式细胞法检测术前和术后1、3、5 d时外周血单核细胞(PBMC)表面HLA-DR/CD14变化情况并分析对阑尾炎穿孔术后切口感染的诊断价值.结果 感染组患儿切口分泌物培养分离病原菌49株,其中革兰阴性菌34株占69.39%,革兰阳性菌15株30.61%,以大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌为主;感染组患儿抗菌药物使用时间和住院时间均长于无感染组(P<0.05);感染组患儿术后1 d、3 d和5 d PB-MC表面HLA-DR/CD14水平均低于无感染组(P<0.05),两组患儿术后1 d、3 d和5 d PBMC表面HLA-DR/CD14水平均高于其术前(P<0.05);术后1 d、3 d和5 d PBMC表面HLA-DR/CD14水平对术后切口感染的受试者工作特征(ROC)曲线下面积分别为0.773、0.754、0.749.结论 阑尾炎穿孔术后切口感染患儿的感染病原菌主要以革兰阴性菌为主,术后PBMC表面HLA-DR/CD14水平较术前水平升高,术后1 d的PBMC表面HLA-DR/CD14水平对患儿术后切口感染有良好的预测效能.OBJECTIVE To investigate human leucocyte antigen DR(HLA-DR)/CD14 on surface of peripheral blood mononuclear cells(PBMC)in children with incision infection after appendicitis perforation surgery and their diagnostic value.METHODS A total of 38 appendicitis perforation children(infection group)with incision infection after laparoscopy in Hangzhou Children's Hospital between Jan.2016 and Dec.2020 and 114 children(non-infection group)with perforated appendicitis treated with the same procedure without infection during the same period were selected as the research subjects.The microbiological characteristics of incision infection were analyzed,the changes of HLA-DR/CD14 on the surface of PBMC were detected by flow cytometry before and at 1 d,3 d and 5 d after surgery,and their diagnostic value for incision infection after appendicitis perforation surgery was analyzed.RESULTS A total of 49 strains of pathogenic bacteria were isolated from the incisional secretions of the infection group,of which 34 strains of gram-negative bacteria accounted for 69.39%and 15 strains of gram-positive bacteria accounted for 30.61%,with Escherichia coli,Pseudomonas aeruginosa and Staphylococcus aureus predominating.The duration of antibiotics use and hospitalization time in infection group were longer than those in non-infection group(P<0.05).At 1d,3d and5d after surgery,levels of HLA-DR/CD14onPBMC surface in infection group were lower than those in non-infection group(P<0.05),and the levels of HLA-DR/CD14 on PBMC surface in both groups were higher than those before surgery(P<0.05).The area under receiver operating characteristic(ROC)curve(AUC)of HLA-DR/CD14 levels on the surface of PBMC at 1 d,3 d and 5 d after surgery for the prediction of postoperative incision infection were 0.773,0.754 and 0.749,respectively.CONCLUSION The main pathogen of incision infection in children after appendicitis perforation surgery is gramnegative bacteria.The levels of HLA-DR/CD14 on the surface of PBMC increase after surgery compared to the preoperative l

关 键 词：阑尾炎穿孔 术后感染 切口感染 外周血单核细胞 人类白细胞抗原DR CD14 临床意义 腹腔镜术 

分 类 号：R619.3[医药卫生—外科学]