TURBT术后医院感染患者淋巴细胞和红细胞免疫变化

目的探讨膀胱肿瘤电切(Transurethral resection of bladder tumor,TURBT)术后医院感染患者急性期反应蛋白、淋巴细胞免疫和红细胞免疫水平变化及其意义。方法选择2017年1月-2018年6月在南阳医学高等专科学校第一附属医院行TURBT患者130例的临床资料进行回顾性分析,42例发生术后感染患者为感染组,88例未感染患者为未感染组。比较两组术后第3天外周血外周急性时相蛋白、T淋巴细胞、红细胞免疫指标。根据APACHEⅡ评分结果,分为轻度危险(8~15分)18例,中度危险(16~19分)15例,严重危险(>20分)9例。比较不同危险程度患者外周血急性时相蛋白、T淋巴细胞、红细胞免疫指标。结果感染组外周C反应蛋白(C-reactive protein,CRP)、α1抗胰蛋白酶(α1 antitrypsin,α1-AT)、α1酸性糖蛋白(α1-acid glycoprotein,α1-AG)水平、CD3^+CD8^+T淋巴细胞、免疫黏附抑制因子(rosette forming inhibitor rate,FEIR)高于未感染组(P<0.05)。感染组外周血CD3^+CD4^+T淋巴细胞、CD16^+CD25^+NK细胞、外周红细胞直向肿瘤红细胞花环率(Direct tumor rosette rate,DTER)、协同肿瘤红细胞花环率(Synergetic tumor red cell rosette rate,ATER)、自然肿瘤红细胞花环率(Natural tumor erythrocytes rate,NTER)、免疫黏附促进因子(Rosette forming enhancement rate,FEER)低于未感染组(P<0.05)。不同病情感染患者CRP、α1-AT、α1-AG、CD3^+CD4^+T、CD3^+CD8^+T、CD16^+CD25^+NK、DTER、ATER、NTER、FEER、FEIR水平存在差异(P<0.05),严重组CRP、α1-AT、α1-AG水平高于轻度组和中度组(P<0.05),中度组CRP、α1-AT、α1-AG水平高于轻度组(P<0.05)。严重组及中度组CD3^+CD4^+T淋巴细胞、CD16^+CD25^+NK细胞水平低于中度组及轻度组(P<0.05);CD3^+CD8^+T淋巴细胞高于中度组及轻度组(P<0.05)。轻度组DTER、ATER、NTER、FEER高于中度组及严重组(P<0.05);FEIR低于中度组及严重组(P<0.05)。结论膀胱肿瘤电切术后医院感染的发生与淋巴细胞及红细胞免疫功能降低具有密切关系。

Research on the immune variations of lymphocytes and erythrocytes in patients with nosocomial infection after TURBT

OBJECTIVE To investigate the changes of acute phase reactive protein,lymphocyte immunity and RBC immunity in patients with nosocomial infection after TURBT.METHODS Clinical data of 130 patients with TURBT in the First Affiliated Hospital of Nanyang Medical College from Jan.2017 to Jun.2018 were analyzed retrospectively.Forty-two patients with postoperative infection were divided into the infection group and 88 uninfected patients were in the uninfected group.The acute phase reactive protein,T lymphocyte and RBC immune indexes were compared between the two groups on the 3 rd day after the operation.According to the ApacheⅡscore,18 patients were classified as mild(8-15 points)risk,15 cases as moderate(16-19 points)risk,and 9 cases as severe(more than 20 points)risk.The acute phase reactive protein,T lymphocyte and RBC immune indexes were compared in peripheral blood of patients with different risk levels.RESULTS The levels of C-reactive protein(CRP),α1-antitrypsin(α1-AT)andα1-acid glycoprotein(α1-ag)in the infected group were significantly higher than that in the uninfected group(P<0.05).Levels of CD3^+CD4^+T lymphocytes,CD16^+CD25^+NK cells,the direct tumor rosette rate(DTER),in the infected group were significantly lower than that in the uninfected group,and level of CD3^+CD8^+T lymphocytes were significantly higher than that in the uninfected group(P<0.05).The direct tumor rosette rate(DTER),synergetic tumor red cell rosette rate(ater),natural tumor rosettes rate(nter),immune adhesion promoting factor(FER)in the infected group were significantly lower than that in the uninfected group(PO<0.05).,the level of immune adherence inhibitor rate(Feir)was significantly higher than that of uninfected group(P<0.05).The levels of CRP,α1-AT,α1-AG,CD3^+CD4^+T,CD3^+CD8^+T,CD16^+CD25^+NK,DTER,ATER,NTER,FEER and FEIR were significantly different(P<0.05):The levels of CRP,α1-AT,α1-AG were significantly higher in the severe group than that in the mild group and the moderate group(P<0.05);The levels of CRP,α1-AT,α1-AG in the moderate group were higher than that in the mild group.The levels of CD3^+CD4^+T lymphocytes and CD16^+CD25^+NK cells in the severe group and moderate group were significantly lower than those in moderate group and mild group(P<0.05);CD3^+CD8^+T lymphocytes were significantly higher than that in moderate group and mild group(P<0.05).Levels of DTER,ATER,NTER and FEER in mild group were significantly higher than that in moderate group and severe group(P<0.05).The level of FEIR in mild group was significantly lower than that in moderate group and severe group(P<0.05).CONCLUSION The increased incidence of nosocomial infection was closely related to the decrease of immune function of lymphocytes and erythrocytes.