传染性疾病免疫功能损伤与围手术期脓毒症相关性研究

目的 了解人类免疫缺陷病毒(HIV)、乙型肝炎病毒(HBV)、结核分枝杆菌(MTU)感染手术病例免疫功能状况与围手术期脓毒症的关系.方法 采用巢式病例对照研究方法,对2009年1月-2010年12月在外科收治的HIV、HBV、MTU感染手术病例进行分析,探讨免疫功能缺陷与围手术期脓毒症的关系.结果 共有298例手术病例纳入研究,分为HIV组144例、HBV组96例、MTU组58例；3组病例脓毒症发生率依次为55.6％、19.8％、53.5％；差异有统计学意义(x2=32.78,P＜0.01),HIV组脓毒症发生率高于HBV组,差异有统计学意义(x2=30.40,P＜0.01),与MTU组差异无统计学意义；HIV组中,肝胆手术脓毒症发生率最高为81.8％,HBV组和TB组中,均以胃肠手术脓毒症发生率最高,分别为36.4％和70.0％；HIV组手术前CD4+T细胞数低于HBV、MTU组,差异均有统计学意义(P＜0.01),CD4/CD8的值低于HBV、MTU组,围手术期脓毒症发生多因素两项logistic回归分析显示,脓毒症发生风险,HIV组是HBV组的6.0倍,MTU组是HBV组的14.3倍,肝胆手术是脾切除术的8.0倍,脓肿清除引流术是脾切除术的6.5倍,术前CD4+T细胞数每减少一个等级,脓毒症发生风险就增加2.1倍；HIV组手术后死亡率为3.5％,高于HBV组的3.1％及MTU组的1.7％.结论 HIV、MTU组较HBV组脓毒症发生率高,不同感染类型、手术分类和术前外周血CD4+T细胞数,是影响围手术期患者脓毒症发生的主要因素.

Research on relationship between immune dysfunction of infectious diseases and perioperative sepsis

OBJECTIVE To investigate the relationship between the immune dysfunction and the perioperative sepsis among the patients infected with HIV,HBV or MTU.METHODS Using nested case-control study,we collected the cases infected with HIV,HBV or MTU in surgical departments from Jan 2009 to Dec 2010 in order to study the relationship between immune dysfunction and perioperative sepsis.RESULTS A total of 298 surgical cases were enrolled and divided into HIV group(n=144),HBV group(n=96) and MTU group(n=58).The incidence of perioperative sepsis was 55.6% in the HIV group,19.8% in the HBV group,and 53.5% in the MTU group,and there were statistical differences among the three groups(χ2=32.78,P<0.01),the incidence of the sepsis was higher in the HIV group than the HBV group,the difference was statistically significant(χ2=30.40,P<0.01),as compared with the MTU group,there was no statistical significance;the incidence of perioperative sepsis was highest(81.8%) in hepatobiliary surgeries in the HIV group,the highest incidence of gastrointestinal surgeries perioperative sepsis was 36.4% and 70.0% in the HBV group and the MTU group,respectively;the preoperative CD4+T cell counts were less in the HIV group than in the HBV group and the MTU group the difference was statistically significant,and the value of preoperative CD4/CD8 was lower in the HIV group than in the HBV group and the MTU group;multivariate logistic binomial regression analysis of the perioperative sepsis indicated that the risk of perioperative sepsis in the HIV group was 6.0 times of the HBV group,the MTU groupwas 14.3 times of the HBV group,the liver and gallbladder surgery was 8.0 times of splenectomy,the abscess drainage clear was 6.5 times of the splenectomy.With the reduction by one grade of the preoperative CD4+T cells,the risk of perioperative sepsis increased 2.1 times.The mortality of the HIV group was 3.5%,and was higher than in the HBV group(3.1%) and in the MTU group(1.7%). CONCLUSION The patients infected with HIV or MTU have higher incidence of the perioperative sepsis than the patients infected with HBV.The main risk factors for the perioperative sepsis include the types of patients infected HIV,HBV or MTU,the classifications of surgeries,and the preoperative peripheral blood CD4+T cell counts.