会阴侧切切口感染危险因素及对患者Th1/Th2细胞因子水平的影响

目的探究会阴侧切切口感染危险因素及对患者Th1/Th2细胞因子水平的影响。方法从2018年1月-2019年1月于乳山市人民医院足月分娩行会阴侧切的产妇中随机抽样150例作为研究对象,根据是否继发切口感染,分为感染组52例和未感染组98例;制定调查表格,收集患者的临床资料,分析感染影响因素。所有受检对象均抽取外周静脉血3 ml,采用流式细胞分选技术(fluorescence-activated cell sorting,FACS)检测Th1、Th2细胞水平,计算Th1/Th2比值,采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)法检测γ-干扰素(Interferon-γ,IFN-γ)、白细胞介素-4(interleukin 4,IL-4)水平,计算两者比值。结果单因素分析显示:体质量指数、产程、妊娠期糖尿病、贫血、羊水污染及感染前住院时间是产妇会阴侧切术后切口感染的影响因素(P<0.05);多因素回归显示:体质量指数≥25 kg/m^2、产程≥8 h、合并妊娠期糖尿病、贫血、羊水污染及感染前住院时间≥72 h是产妇会阴侧切术后切口感染的危险因素(P<0.05);感染组的Th1细胞(15.29±4.52)、Th2细胞(7.13±2.89)高于非感染组,而Th1/Th2比值(2.47±0.86)低于非感染组(P<0.05);感染组的血清IFN-γ(31.46±4.19)pg/ml、IL-4(23.42±2.87)pg/ml高于非感染组,而IFN-γ/IL-4(1.25±0.13)低于非感染组(P<0.05)。结论产妇会阴侧切术后切口感染的影响因素较多,应采取针对性的干预措施,降低感染发生率。侧切切口感染产妇体内存在Th细胞亚群失衡现象,炎症因子水平紊乱。

Risk factors of perineal incision infection and its effect on Th1/Th2 cytokine levels

OBJECTIVE To explore the risk factors of perineal incision infection and its effect on Th1/Th2 cytokine levels in patients.METHODS From January 2018 to January 2019,a random sample of 150 women who underwent perineal lateral resection in the Rushan People’s Hospital during full-term labor was recruited as the research subjects.According to whether secondary incision infection occurred,they were divided into the infection group(n=52)and the uninfected group(n=98).A survey form,clinical and experimental data of the patients were recorded,and the risk factors of infection were analyzed.About 3 ml of peripheral venous blood was collected from all subjects,which was used to detect Th1 and Th2 cell counts by flow cytometry(FACS)and to calculate Th1/Th2 ratio.Enzyme linked immunosorbent assay(ELISA)was used to detect levels of IFN-γand IL-4.RESULTS Body mass index,labor course,gestational diabetes mellitus,anemia,amniotic fluid infection,and hospitalization time before infection were the risk factors of incision infection after maternal perineal incision(P<0.05)by univariate analysis;multivariate regression showed that body mass index≥25 kg/m^2,labor duration≥8 h,combined with gestational diabetes mellitus,anemia,contamination of amniotic fluid,and hospital stay≥72 h were risk factors for incisional infection after perineal lateral resection(P<0.05).The percentage of Th1 cells(15.29±4.52)and Th2 cells(7.13±2.89)in the infection group were higher than that in the non-infected group.However,the ratio of Th1/Th2(2.47±0.86)in the infection group was significantly lower than that in the non-infected group(P<0.05).Serum levels of IFN-γ(31.46±4.19)pg/ml and IL-4(23.42±2.86)pg/ml in the infected group were significantly higher than that in the non-infected group,respectively,whereas IFN-γ/IL-4(1.25±0.13)was significantly lower than that in the non-infected group(P<0.05).CONCLUSION There were many influencing factors of wound infection after maternal perineal surgery.Intervention should be taken to reduce the incidence of infection.There was an imbalance of Th cell subsets in the women with lateral incision infection,and the levels of inflammatory factors was derangement.