重症急性胰腺炎继发脓毒症与肠道细菌易位、炎症及免疫抑制的关系

发布时间：2018-03-11 00:13

本文选题：重症急性胰腺炎　切入点：脓毒症　出处：《中国病原生物学杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的探讨重症急性胰腺炎(SAP)脓毒症的发生与肠道细菌易位、炎症及免疫抑制的关系。方法 2012年3月-2016年10月本院重症医学科收治的SAP患者160例,按脓毒症诊断标准分为脓毒症组(63例)和非脓毒症组(97例)。采集患者胰腺周围渗液进行细菌培养,同时留取尿液及血液标本用于肠粘膜通透性、炎症及免疫相关指标的检测。结果 160例SAP患者胰腺周围渗液中共分离出225株细菌,主要为革兰阴性菌(81.78%),包括大肠埃希菌、铜绿假单胞杆菌、产气杆菌、肺炎克雷伯菌,革兰阳性菌(18.22%)包括金黄色葡萄球菌、表皮葡萄球菌和肠球菌,脓毒症和非脓毒症组细菌构成基本一致;脓毒症组患者血清内毒素(ET)[(0.62±0.06)EU/ml]、肿瘤坏死因子α(TNF-α)[(4.44±0.07)g/L]、白细胞介素1β(IL-1β)[(1.86±0.22)μg/L、IL-6(239.40±38.93)]、IL-8[(0.55±0.12)μg/L]水平,乳果糖与甘露醇排泄率比值(L/M)(0.54±0.08)以及外周血调节性T细胞(Treg)水平[(10.64±1.50)%]均显著高于非脓毒症组(P0.05),T辅助淋巴细胞1/2(Th1/Th2)值(0.84±0.34)低于非脓毒症组(P0.05)。结论 SAP脓毒症的发生与肠源性细菌易位、炎症因子的过度释放及免疫抑制等因素所导致的肠屏障功能受损密切相关。
[Abstract]:Objective to investigate the relationship between sepsis of severe acute pancreatitis (SAP) and intestinal bacterial translocation, inflammation and immunosuppression. Methods from March 2012 to October 2016, 160 patients with SAP were treated in our hospital. According to the diagnostic criteria of sepsis, the patients were divided into sepsis group (n = 63) and non-sepsis group (n = 97). The peripancreatic effusion was collected for bacterial culture, and urine and blood samples were collected for intestinal mucosal permeability. Results A total of 225 strains of bacteria were isolated from peripancreatic exudate of 160 patients with SAP, mainly Gram-negative bacteria, including Escherichia coli, Pseudomonas aeruginosa, Aerobacterium pneumoniae, Klebsiella pneumoniae. Gram-positive bacteria include Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus, septic group and non-septic group, the bacterial composition of sepsis group is basically the same, the serum endotoxin et (0.62 卤0.06 EUP / ml), tumor necrosis factor- 伪 (TNF- 伪) [4.44 卤0.07g / L], IL-1 尾 [1.86 卤0.22) 渭 g / L IL-6239.40 卤38.93 渭 g / L] IL-8 [0.55 卤0.12 渭 g / L] in sepsis group. The ratio of lactulose to mannitol excretion rate and the level of T cells in peripheral blood [10. 64 卤1. 50%] were significantly higher than those in non septic patients (P 0. 05 T helper lymphocytes 1 / 2 Th1 / Th2 + 0. 84 卤0. 34). Conclusion the occurrence of SAP sepsis is associated with the translocation of enterogenous bacteria. Excessive release of inflammatory factors and immunosuppressive factors are closely related to impaired intestinal barrier function.
【作者单位】：广元市中心医院重症医学科;广元市第三人民医院重症医学科;
【分类号】：R459.7;R576

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