闭塞性细支气管炎患儿医院感染相关因素及血清炎性因子水平
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摘要
目的调查闭塞性细支气管炎(bronchiolitis obliterans,BO)患儿医院感染的相关因素及患儿血清炎性因子指标水平的变化情况。方法选取2012年12月-2016年12月医院收治的BO患儿248例为研究对象,对患儿发生闭塞性细支气管炎的医院感染情况进行统计,分析导致患儿BO医院感染的相关因素,并对感染患儿和未感染患儿的血清炎症因子和T细胞亚群指标进行观察。结果 248例BO患儿发生医院感染58例,感染率为23.39%;年龄、血沉、高热持续时间、胸腔积液、肺部哮鸣音和剧烈咳嗽是BO患儿医院感染的相关因素(P<0.05);感染患儿肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、IL-6、IL-8和IL-12分别为(24.11±7.21)ng/L、(96.22±40.11)ng/L、(253.36±50.56)ng/L、(99.23±38.66)ng/L、(134.33±43.77)ng/L血清炎症因子水平均高于未感染患儿(P<0.001);感染患儿CD3+CD4+和CD3+CD8+分别为(410.19±106.84)细胞/μl、(321.20±132.20)细胞/μl低于未感染患儿(P<0.001)。结论小儿BO医院感染应引起临床重视,感染发生与多个因素有关,感染可导致患儿免疫指标降低促炎因子和抗炎因子水平升高,针对上述指标的检测对于感染的监控具有重要的意义。
OBJECTIVE To investigate the risk factors of nosocomial infections of children with obstructive bronchiolitis(BO),and the changes of serum inflammatory factors in children.METHODS A total of 248 children with obstructive bronchiolitis in our hospital from Dec.2012 to Dec.2016 were chosen.The prevalence of nosocomial infections in children with bronchiolitis was taken for statistics.Univariate and multivariate analysis were used to analyze the risk factors of nosocomial infections in children with obstructive bronchiolitis.And the serum inflammatory factors and T cell subsets of infected and non-infected patients were observed and compared.RESULTS Totally 58 cases were of nosocomial infections in the 248 cases of children with occlusive bronchiolitis,and the incidence of nosocomial infections was 23.39%.The age,erythrocyte sedimentation rate,high fever duration,pleural effusion,lung wheeze,and severe cough were the risk factors of nosocomial infections in children with BO(P<0.05).The levels of tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interleukin-6(IL-6),interleukin-8(IL-8)and interleukin-12(IL-12)of children with infection were(24.11±7.21)ng/L,(96.22±40.11)ng/L,(253.36±50.56)ng/L,(99.23±38.66)ng/L and(134.33±43.77)ng/L,which were significantly higher than those of children without infection(P<0.001).The CD3+CD4+and CD3+CD8+of children with infection were(410.19±106.84)cells/μl and(321.20±132.20)cells/μl,which were significantly lower than those of children without infection(P<0.05).CONCLUSIONThe nosocomial infection of children with occlusive bronchiolitis should be paid to clinical attention.The occurrence of infection is associated with multiple risk factors,and the infection can lead to a significant decrease of immune indicators and a significant increase of proinflammatory and anti-inflammatory factors of children,so the detection of those indexes has important significance for the monitoring of infection.
OBJECTIVE To investigate the risk factors of nosocomial infections of children with obstructive bronchiolitis(BO),and the changes of serum inflammatory factors in children.METHODS A total of 248 children with obstructive bronchiolitis in our hospital from Dec.2012 to Dec.2016 were chosen.The prevalence of nosocomial infections in children with bronchiolitis was taken for statistics.Univariate and multivariate analysis were used to analyze the risk factors of nosocomial infections in children with obstructive bronchiolitis.And the serum inflammatory factors and T cell subsets of infected and non-infected patients were observed and compared.RESULTS Totally 58 cases were of nosocomial infections in the 248 cases of children with occlusive bronchiolitis,and the incidence of nosocomial infections was 23.39%.The age,erythrocyte sedimentation rate,high fever duration,pleural effusion,lung wheeze,and severe cough were the risk factors of nosocomial infections in children with BO(P<0.05).The levels of tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interleukin-6(IL-6),interleukin-8(IL-8)and interleukin-12(IL-12)of children with infection were(24.11±7.21)ng/L,(96.22±40.11)ng/L,(253.36±50.56)ng/L,(99.23±38.66)ng/L and(134.33±43.77)ng/L,which were significantly higher than those of children without infection(P<0.001).The CD3+CD4+and CD3+CD8+of children with infection were(410.19±106.84)cells/μl and(321.20±132.20)cells/μl,which were significantly lower than those of children without infection(P<0.05).CONCLUSIONThe nosocomial infection of children with occlusive bronchiolitis should be paid to clinical attention.The occurrence of infection is associated with multiple risk factors,and the infection can lead to a significant decrease of immune indicators and a significant increase of proinflammatory and anti-inflammatory factors of children,so the detection of those indexes has important significance for the monitoring of infection.
引文
[1]刘兆润,张俊丽,吴国刚,等.呼吸机相关性气管支气管炎的微生物学诊断[J].中华医院感染学杂志,2016,26(20):4785-4787.
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[6]Ciaramelli C,Fumagalli M,Viglio S,et al.1H NMR to evaluate the metabolome of bronchoalveolar lavage fluid(BALf)in bronchiolitis obliterans syndrome(BOS):toward the development of a new approach for biomarker identification[J].J Proteome Res,2017,16(4):1669-1682.
[7]韩青,史彧,李红霞,等.儿童闭塞性支气管炎合并闭塞性细支气管炎伴机化性肺炎一例并文献复习[J].中华儿科杂志,2016,54(7):523-526.
[8]Del Fante C,Perotti C.Extracorporeal photopheresis for bronchiolitis obliterans syndrome after allogeneic stem cell transplant:an emerging therapeutic approach[J].Transfus Apher Sci,2017,56(1):17-19.
[9]张季红,张晓英,孙光辉,等.毛细支气管炎患儿医院感染的病原学与抗感染治疗效果[J].中华医院感染学杂志,2016,26(11):2587-2589.
[10]Grnningster IS,Tsykunova G,Lilleeng K,et al.Bronchiolitis obliterans syndrome in adults after allogeneic stem cell transplantation-pathophysiology,diagnostics and treatment[J].Expert Rev Clin Immunol,2017,13(6):553-569.
[11]Keller CA,Gonwa TA,Hodge DO,et al.Feasibility,safety,and tolerance of mesenchymal stem cell therapy for obstructive chronic lung allograft dysfunction[J].Stem Cells Transl Med,2018,7(2):161-167.
[12]Sithamparanathan S,Thirugnanasothy L,Morley KE,et al.Observational study of methotrexate in the treatment of bronchiolitis obliterans syndrome[J].Transplant Proc,2016,48(10):3387-3392.
[13]Benzimra M,Calligaro GL,Glanville AR.Acute rejection[J].J Thorac Dis,2017,9(12):5440-5457.
[14]Orime M,Tomiyama K,Hashidate H,et al.Non-paraneoplastic autoimmune subepidermal bullous disease associated with fatal bronchiolitis obliterans[J].J Dermatol,2017,44(4):461-464.
[15]Williams KM.How I treat bronchiolitis obliterans syndrome after hematopoietic stem celltransplantation[J].Blood,2017,129(4):448-455.
[16]Morrison MI,Pither TL,Fisher AJ.Pathophysiology and classification of primary graft dysfunction after lung transplantation[J].J Thorac Dis,2017,9(10):4084-4097.
[17]Gur M,Yaacoby-Bianu K,Ilivitzki A,et al.Lung clearance index(LCI)in patients with bronchiolitis obliterans:apreliminary report and comparison to cystic fibrosis patients[J].Lung,2016,194(6):1007-1013.
[18]Lee SH,Park MS,Song JH,et al.Perioperative factors associated with 1-year mortality after lung transplantation:a single-center experience in Korea[J].J Thorac Dis,2017,9(10):4006-4016.
[19]Verleden SE,Vos R,Vandermeulen E,et al.Parametric response mapping of bronchiolitis obliterans syndrome progression after lung transplantation[J].Am J Transplant,2016,16(11):3262-3269.
[2]Togni Filho PH,Casagrande JLM,Lederman HM.Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant:reducing patient radiation exposure[J].Radiol Bras,2017,50(2):90-96.
[3]李芹,高文杰,张蕾,等.麻疹并发闭塞性细支气管炎患儿六例临床分析[J].中国全科医学,2017,20(6):751-754.
[4]Densmore JC,Schaid TR,Jeziorczak PM,et al.Lung injury pathways:adenosine receptor 2Bsignaling limits development of ischemic bronchiolitis obliterans organizing pneumonia[J].Exp Lung Res,2017,43(1):38-48.
[5]侯杰.现代肺弥漫性疾病学[M].北京:人民出版社,2003,226-273.
[6]Ciaramelli C,Fumagalli M,Viglio S,et al.1H NMR to evaluate the metabolome of bronchoalveolar lavage fluid(BALf)in bronchiolitis obliterans syndrome(BOS):toward the development of a new approach for biomarker identification[J].J Proteome Res,2017,16(4):1669-1682.
[7]韩青,史彧,李红霞,等.儿童闭塞性支气管炎合并闭塞性细支气管炎伴机化性肺炎一例并文献复习[J].中华儿科杂志,2016,54(7):523-526.
[8]Del Fante C,Perotti C.Extracorporeal photopheresis for bronchiolitis obliterans syndrome after allogeneic stem cell transplant:an emerging therapeutic approach[J].Transfus Apher Sci,2017,56(1):17-19.
[9]张季红,张晓英,孙光辉,等.毛细支气管炎患儿医院感染的病原学与抗感染治疗效果[J].中华医院感染学杂志,2016,26(11):2587-2589.
[10]Grnningster IS,Tsykunova G,Lilleeng K,et al.Bronchiolitis obliterans syndrome in adults after allogeneic stem cell transplantation-pathophysiology,diagnostics and treatment[J].Expert Rev Clin Immunol,2017,13(6):553-569.
[11]Keller CA,Gonwa TA,Hodge DO,et al.Feasibility,safety,and tolerance of mesenchymal stem cell therapy for obstructive chronic lung allograft dysfunction[J].Stem Cells Transl Med,2018,7(2):161-167.
[12]Sithamparanathan S,Thirugnanasothy L,Morley KE,et al.Observational study of methotrexate in the treatment of bronchiolitis obliterans syndrome[J].Transplant Proc,2016,48(10):3387-3392.
[13]Benzimra M,Calligaro GL,Glanville AR.Acute rejection[J].J Thorac Dis,2017,9(12):5440-5457.
[14]Orime M,Tomiyama K,Hashidate H,et al.Non-paraneoplastic autoimmune subepidermal bullous disease associated with fatal bronchiolitis obliterans[J].J Dermatol,2017,44(4):461-464.
[15]Williams KM.How I treat bronchiolitis obliterans syndrome after hematopoietic stem celltransplantation[J].Blood,2017,129(4):448-455.
[16]Morrison MI,Pither TL,Fisher AJ.Pathophysiology and classification of primary graft dysfunction after lung transplantation[J].J Thorac Dis,2017,9(10):4084-4097.
[17]Gur M,Yaacoby-Bianu K,Ilivitzki A,et al.Lung clearance index(LCI)in patients with bronchiolitis obliterans:apreliminary report and comparison to cystic fibrosis patients[J].Lung,2016,194(6):1007-1013.
[18]Lee SH,Park MS,Song JH,et al.Perioperative factors associated with 1-year mortality after lung transplantation:a single-center experience in Korea[J].J Thorac Dis,2017,9(10):4006-4016.
[19]Verleden SE,Vos R,Vandermeulen E,et al.Parametric response mapping of bronchiolitis obliterans syndrome progression after lung transplantation[J].Am J Transplant,2016,16(11):3262-3269.