剖宫产术后切口感染炎性指标与免疫应激的相关性

目的分析剖宫产术后切口感染患者炎性指标与免疫应激的相关性。方法选取2017年1月-2019年12月天津市第五中心医院96例剖宫产术后切口感染患者为研究组,选取100例未发生术后切口感染的剖宫产产妇为对照组。对两组产妇术前及术后3 d血清白细胞介素(IL)-6、IL-1、IL-8、肿瘤坏死因子(TNF)-α、血管紧张素Ⅱ(AT-Ⅱ)、皮质醇(Cor)、胰岛素(INS)、去甲肾上腺素(NE)水平及外周血CD8⁺T淋巴细胞比例、CD4⁺T淋巴细胞比例、自然杀伤细胞(NK)比例进行检测和分析。结果研究组产妇术后血清炎症因子、应激激素水平及外周血CD8⁺T淋巴细胞比例均较术前上升,外周血CD4⁺T淋巴细胞比例、NK细胞比例均较术前下降,手术前、后上述指标变化幅度均高于对照组,差异均有统计学意义(P<0.05)。感染患者血清炎症因子水平与血清应激激素水平及外周血CD8⁺T淋巴细胞比例均呈正相关关系(P<0.05),与外周血CD4⁺T淋巴细胞比例、NK细胞比例均呈负相关关系(P<0.05)。结论剖宫产术后切口感染患者血清炎性因子表达上调与细胞免疫功能下降、应激指标相关,其炎症状态可能与免疫应激损害有关,临床医生应积极采取有效措施维持其机体稳态,从而达到促进康复、改善预后的目的。

Correlation between inflammatory indicators and immune stress of cesarean section patients with postoperative incision infection

OBJECTIVE To analyze the correlation between inflammatory indicators and immune stress of the cesarean section patients with postoperative incision infection.METHODS Totally 96 patients who underwent cesarean section and had postoperative incision infection in Tianjin Fifth Central Hospital from Jan 2017 to Dec 2019 were assigned as the study group,and 100 puerpera who received cesarean section but did not have postoperative incision infection were set as the control group.The levels of serum interleukin(IL)-6,IL-1,IL-8,tumor necrosis factor(TNF)-α,angiotensinⅡ(AT-Ⅱ),cortisol(Cor),insulin(INS),norepinephrine(NE)and peripheral blood CD8⁺T lymphocytes percentage,CD4⁺T lymphocytes percentage and natural killer(NK)cells were detected and compared between the two groups of puerpera before the surgery and after the surgery for 3 days.RESULTS The levels of serum inflammatory factors,stress hormones and peripheral blood CD8⁺T lymphocytes percentage of the study group were significantly higher after the surgery than before the surgery,the peripheral blood CD4⁺T lymphocyte percentage and NK cell percentage were significantly lower after the surgery than before the surgery,and the above indexes changed more significantly in the study group than in the control group before and after the surgery(P<0.05).The levels of serum inflammatory factors of the patients with infection were positively correlated with the levels of serum stress hormones and peripheral blood CD8⁺T lymphocyte(P<0.05)but were negatively correlated with the peripheral blood CD4⁺T lymphocyte percentage and NK cell percentage(P<0.05).CONCLUSION The up-regulation of serum inflammatory factors in the cesarean section patients is associated with the decline of cellular immune function and the levels of stress indexes,and the inflammatory state of the patients may be related to the immune stress damage.It is necessary for the clinicians to take effective measures to maintain the homeostasis of the patients so as to promote the recovery and improve the prognosis.