慢加急性乙型肝炎肝衰竭患者医院感染病原菌分布及血清Th1/Th2型细胞因子水平变化*

doi:10.3969/j.issn.1672-5069.2023.02.024

摘要/Abstract

摘要： 目的探讨慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者医院感染(NI)病原菌分布及血清Th1/Th2型细胞因子水平变化。方法 2019年12月～2021年12月我院收治的HBV-ACLF患者63例,其中发生NI者35例,未感染28例;采用ELISA法检测血清Th1细胞因子白介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)和干扰素-γ(IFN-γ),和Th2细胞因子IL-4、IL-6和IL-10水平,使用免疫荧光法检测血清C-反应蛋白(CRP)和降钙素原(PCT),采用鲎试验检测血清内毒素(LPS)水平。常规分离和鉴定菌种。结果在35例HBV-ACLF并发感染患者中,共分离鉴定出病原菌72株,其中革兰阴性菌44株,革兰阳性菌28株;HBV-ACLF并发感染患者血清CRP、PCT和LPS水平分别为(78.7±12.9)mg/L、(6.2±0.2)ng/mL和(0.9±0.1)EU/ml,显著高于HBV-ACLF未并发感染组[分别为(15.9±1.7)mg/L、(0.9±0.1)ng/mL和(0.2±0.1)EU/ml,P<0.05];并发感染患者血清TNF-α、IFN-γ和IL-6水平分别为(16.5±1.7)pg/mL、(27.8±2.3)pg/mL和(12.5±1.3)pg/mL,均显著高于未并发感染患者[分别为(11.7±1.2)pg/mL、(20.2±2.1)pg/mL和(4.2±0.4)pg/mL,P<0.05],而血清IL-2、IL-4和IL-10水平分别为(3.3±0.3)pg/mL、(11.8±1.1)pg/mL和(10.2±1.0)pg/mL,P<0.05];HBV-ACLF并发感染患者28 d和90 d生存率分别为28.6%和20.0%,显著低于未并发感染患者的71.4%(x²=8.239,P=0.022)和57.1%(x²=7.014,P=0.025)。结论 HBV-ACLF患者并发细菌感染以革兰阴性菌为主,短期病死率显著增高,合并存在Th1/Th2型细胞因子水平紊乱。

关键词: 慢加急性肝衰竭, 医院感染, 病原菌, Th1/Th2型细胞因子

Abstract: Objective The aim of this study was to investigate the distribution of pathogens and serum Th1/Th2 cytokine changes in patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) and nosocomial infections (NI). Methods 63 patients with HBV-ACLF were admitted to our hospital between December 2019 and December 2021, and out of them, 35 patients were found having NI. Serum Th1 cytokines, such as interleukin-2 (IL-2), tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), and Th2 cytokines, including IL-4, IL -6 and IL-10 levels were detected by ELISA. Serum C-reactive protein (CRP) and procalcitonin (PCT) levels were detected by immunofluorescence, and serum lipopolysaccharide (LPS) level was detected by limulus test. The isolation and identification of pathogens were conducted by microbiological analyzer. Results In the 35 HBV-ACLF patients with NI, 72 strains of pathogens, including 44 strains of Gram-negative and 28 strains of Gram-positive bacteria were found; serum CRP, PCT and LPS levels in patients with NI were (78.7±12.9)mg/L,(6.2±0.2)ng/mL and (0.9±0.1)EU/ml, significantly higher than [(15.9±1.7)mg/L, (0.9±0.1)ng/mL and (0.2±0.1)EU/ml, respectively, P<0.05] in patients without NI; serum TNF-α, IFN-γ and IL-6 levels in patients with NI were (16.5±1.7)pg/mL, (27.8±2.3)pg/mL and (12.5±1.3)pg/mL, all significantly higher than [(11.7±1.2)pg/mL, (20.2±2.1)pg/mL and (4.2±0.4)pg/mL, respectively, P<0.05], while serum IL-2, IL-4 and IL-10 levels were (3.3±0.3)pg/mL, (11.8±1.1)pg/mL and (10.2±1.0)pg/mL, respectively, P<0.05] in patients without NI; the 28 d and 90 d survivals in patients with NI were 28.6% and 20.0%, both significantly lower than 71.4%(x²=8.239, P=0.022) and 57.1%(x²=7.014, P=0.025) in patients without NI. Conclusion The mortality of HBV-ACLF patients with NI is high, and the main pathogens of bacterial infection is Gram-negative bacteria, which might have the Th1/Th2 cytokine imbalance.

Key words: Acute-on-chronic liver failure, Nosocomial infection, Pathogens, Th1/Th2 cytokines

程晓燕, 赵爱明, 李海丹, 万艳红, 庞慧贤. 慢加急性乙型肝炎肝衰竭患者医院感染病原菌分布及血清Th1/Th2型细胞因子水平变化^*[J]. 实用肝脏病杂志, 2023, 26(2): 246-249.

Cheng Xiaoyan, Zhao Aiming, Li Haidan, et al.. Distribution of pathogens and serum Th1/Th2 cytokine changes in patients with hepatitis B virus related acute-on-chronic liver failure and nosocomial infections[J]. Journal of Practical Hepatology, 2023, 26(2): 246-249.

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慢加急性乙型肝炎肝衰竭患者医院感染病原菌分布及血清Th1/Th2型细胞因子水平变化^*

Distribution of pathogens and serum Th1/Th2 cytokine changes in patients with hepatitis B virus related acute-on-chronic liver failure and nosocomial infections

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