感染性角膜炎病原学及IL-17/IL-23炎症通路检测价值

目的探讨感染性角膜炎患者病原学分布特点及白细胞介素-17(Interleukin-17,IL-17)/白细胞介素-23(Interleukin-23、IL-23)炎症通路检测价值。方法选择2018年1月-2020年1月海南西部中心医院眼科收治的感染性角膜炎患者106例作为研究组。选择同期医院收治的近视患者40例作为对照组。采集患者眼部分泌物标本,进行病原菌培养与鉴定;比较两组患者及研究组内不同疾病严重程度、不同治疗转归患者血清C-反应蛋白(C reactive protein,CRP)、降钙素原(Procalcitonin,PCT)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、IL-17、IL-23中的表达差异。结果 106例患者共检出病原菌115株,有6例患者存在细菌、真菌混合感染。共检出真菌61株,占53.04%,细菌54株,占46.96%;研究组CRP、PCT、TNF-α、IL-17、IL-23水平(11.06±3.31)mg/L、(0.61±0.20)ng/ml、(19.33±6.21)ng/ml、(43.27±16.20)ng/ml、(37.34±14.43)ng/ml均高于对照组(P<0.05);重度组患者上述指标水平高于中度组和轻度组;治疗无效组患者上述指标水平高于有效组和治愈组(P<0.05),有效组患者血清CRP、PCT、TNF-α、IL-17、IL-23水平高于治愈组(P<0.05)。结论本院感染性角膜炎以真菌性角膜炎为主,其中镰刀菌、曲霉菌检出率较高,在用药时应有侧重;血清IL-17、IL-23水平可反映感染严重程度及治疗转归,其临床价值有待进一步检验。

Etiological characteristics of infectious keratitis and value of IL-17/IL-23 inflammation pathway

OBJECTIVE To explore the etiological characteristics of infectious keratitis and analyze the value of interleukin-17(IL-17)/interleukin-23(IL-23)inflammatory pathway.METHODS Totally 106 patients with infectious keratitis who were treated in ophthalmology department of the Hainan West Central Hospital from Jan 2018 to Jan 2020 were chosen as the study group,meanwhile,40 myopia patients were set as the control group.The secretions specimens were collected from the eyes of the patients and were cultured for pathogens,and the levels of serum C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),IL-17 and IL-23 were observed and compared between the two groups of patients,among the patients with different severities of diseases,and among the patients with different treatment outcomes.RESULTS A total of 115 strains of pathogens were isolated from 106 patients,6 patients had mixed infections with bacteria and fungi.There were 61(53.04%)strains of fungi and 54(46.96%)strains of bacteria.The levels of CRP,PCT,TNF-α,IL-17 and IL-23 of the study group were respectively(11.06±3.31)mg/L,(0.61±0.20)ng/ml,(19.33±6.21)ng/ml,(43.27±16.20)ng/ml and(37.34±14.43)ng/ml,significantly higher than those of the control group(P<0.05).The levels of the above indexes of the severe group were significantly higher than those of the moderate group and the mild group;the levels of the above indexes of the ineffective treatment group were significantly higher than those of the effective group and the cured group(P<0.05).The levels of serum CRP,PCT,TNF-α,IL-17 and IL-23 of the effective group were significantly higher than those of the cured group(P<0.05).CONCLUSION The patients with fungal keratitis are dominant among the patients with infectious keratitis,the isolation rates of Fusarium and Aspergillus are high,to which should be attached great importance during the medication.The serum IL-17 and IL-23 may reflect the severity of infection and treatment outcomes,and their clinical value need to be further verified.