葛西手术后并发胆管炎患儿血清细菌DNA的检测

发布时间：2018-05-07 04:29

本文选题：细菌DNA + 胆管炎　；参考：《重庆医科大学》2016年硕士论文

【摘要】：目的葛西手术后胆管炎是胆道闭锁患儿行葛西手术治疗后一常见且较为严重的术后并发症。本研究通过检测患儿血清中的细菌DNA来研究葛西手术后并发胆管炎患儿细菌DNA的检测率以及与之相关的临床因素。方法通过对110例接受葛西手术患儿的横向研究,110例患儿中包括77例术后并发胆管炎患儿以及33例术后未并发胆管炎患儿。血液样本在取得患儿家属同意的情况下采集或门诊随访复查时采集。通过PCR技术检测细菌DNA,并通过DNA核苷酸测序来确定细菌的菌属。结果对于血清中细菌的检测16SrDNA检测方法较血培养方法灵敏(58.4%vs 14.3%,p0.0001);术后并发胆管炎组较术后未并发胆管炎组的血清细菌DNA检测率明显增加(58.4%vs 39.4%,p=0.095)。血清中的16SrDNA主要来源于肠道内的机会致病菌,包括大肠埃希氏菌,肺炎克雷伯杆菌,志贺氏菌,肠杆菌菌属。益生菌治疗或抗生素应用能部分降低血清中细菌DNA水平。儿童终末期肝病模型评分,血清PCT水平,血清CRP水平,心率与细菌DNA检测率相关。结论患儿血清中检测到的细菌DNA同肠道内的细菌DNA类似,并且术后并发胆管炎组较术后未并发胆管炎组以及对照组血清更常检测到细菌DNA。这些结果均表明16SrDNA检测技术可用于葛西手术后并发胆管炎以及其他感染的早期诊断。
[Abstract]:Objective: cholangitis after Gesi operation is a common and serious postoperative complication in children with biliary atresia. The purpose of this study was to study the detection rate of bacterial DNA in children with cholangitis after Gesi operation and its clinical factors by detecting bacterial DNA in serum of children with cholangitis. Methods A transverse study was conducted in 110 children with cholangitis and 33 children without cholangitis after operation. Blood samples were collected with the consent of the child's family or during outpatient follow-up. The bacterial DNA was detected by PCR and the genus of bacteria was determined by DNA nucleotide sequencing. Results the detection of bacteria in serum by 16SrDNA method was more sensitive than that by blood culture method (58.4 vs 14.3), and the detection rate of serum bacterial DNA in postoperative complicated cholangitis group was significantly higher than that in non-postoperative cholangitis group (58.4 vs 39.4%). 16SrDNA in serum is mainly derived from opportunistic bacteria in the intestine, including Escherichia coli, Klebsiella pneumoniae, Shigella and Enterobacter spp. Probiotics therapy or antibiotic use can partially reduce the level of bacterial DNA in serum. The model score, serum PCT level, serum CRP level and heart rate were correlated with bacterial DNA detection rate in children with end-stage liver disease. Conclusion bacterial DNA detected in serum of children is similar to bacterial DNA in intestinal tract, and bacterial DNA is more frequently detected in serum of children with cholangitis after operation than that with cholangitis after operation and without cholangitis after operation. These results suggest that 16SrDNA can be used in the early diagnosis of cholangitis and other infections after Gesi's operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R726.5

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