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目的探讨烧伤创面感染病原菌分布及创面感染过程中血清免疫细胞的变化,为临床诊断、合理用药提供参考。方法从2015年1月至2015年12月接受治疗的烧伤感染患者的标本中分离出来的1 082株病原菌,并随机抽取265例细菌感染患者(感染组)及200例健康体检者,采用流式细胞技术检测血液中B细胞、NK细胞、T细胞及其细胞亚群,并对结果进行比较分析。结果分离出的1 082株病原菌中,有697例革兰阴性杆菌,占64.4%,主要为铜绿假单胞菌、鲍氏不动杆菌等;有361株革兰阳性杆菌,占33.4%,主要为金黄色葡萄球以及肠球菌属;真菌比例仅占2.2%,主要为白色假丝酵母菌。流式细胞仪检测结果显示,与对照组相比,感染组患者的T4细胞、T4/T8、DN-T细胞值明显降低,T8细胞明显增高,差异均有统计学意义(P<0.05,P<0.01)。铜绿假单胞菌组B细胞显著高于对照组,NK细胞显著低于对照组(P<0.05,P<0.01);与对照组相比,除金黄色葡萄球菌感染组外,其他细菌感染组中T4细胞显著降低,T8细胞明显增高,而T4/T8比值明显降低(P<0.05,P<0.01)。结论不同细菌种属感染的患者机体免疫细胞数量存在一定差异,大部分细菌感染患者可能出现淋巴细胞亚群失衡和细胞免疫功能紊乱。
Objective To investigate the distribution of pathogenic bacteria in wound infection and the changes of serum immune cells during wound infection in order to provide reference for clinical diagnosis and rational drug use. Methods A total of 1 082 strains of pathogens isolated from specimens of burn-infected patients who were treated from January 2015 to December 2015 were collected and randomly collected from 265 patients with bacterial infection (infection group) and 200 healthy subjects. Cell technology to detect blood B cells, NK cells, T cells and their cell subsets, and the results were compared. Results Of the 1082 isolates isolated, 697 Gram-negative bacilli accounted for 64.4%, mainly Pseudomonas aeruginosa and Acinetobacter baumannii; there were 361 Gram-positive bacilli (33.4%), mainly Staphylococcus aureus and Enterococcus; fungi accounted for only 2.2%, mainly Candida albicans. Flow cytometry results showed that compared with the control group, the number of T4 cells, T4 / T8 and DN-T cells in the infected group was significantly decreased and the T8 cells were significantly increased, the difference was statistically significant (P <0.05, P <0.01). The number of B cells in Pseudomonas aeruginosa group was significantly higher than that in control group, NK cells were significantly lower than those in control group (P <0.05, P <0.01). Compared with control group, other bacterial infection groups except S. aureus group T4 cells were significantly decreased, T8 cells were significantly increased, while the T4 / T8 ratio was significantly lower (P <0.05, P <0.01). Conclusion There are some differences in the number of immune cells in patients infected with different bacterial species. Most patients with bacterial infection may have imbalance of lymphocyte subsets and cellular immune dysfunction.