【摘要】 目的 探讨宫颈癌术后感染患者的病原谱分布及耐药性特征，并分析调节性T细胞(Treg)水平与血小板反应指标在术后感染发生及耐药菌感染中的相关性，为宫颈癌术后感染防控及免疫监测提供依据。方法 采用前瞻性观察性研究设计，纳入2023年3～9月于本院接受根治性手术的宫颈癌患者302例，依据术后30 d内感染诊断标准分为感染组(n=47)与非感染组(n=255)。术后48 h采集外周血检测Treg比例(流式细胞术)及血小板参数[血小板/淋巴细胞比值(PLR)、平均血小板体积(MPV)、血小板分布宽度(PDW)及血小板压积(PCT)]。感染组同时采集切口分泌物、盆腔引流液、尿液及血培养标本进行病原学检测和药敏分析。以Logistic回归分析术后感染的独立危险因素，并采用Spearman相关分析Treg、血小板指标与病原菌耐药等级及感染严重程度的关系。结果 术后感染发生率为15.56%(47/302),病原学阳性率82.98%(39/47),共分离53株病原体。革兰阴性菌占58.49%(31/53),革兰阳性菌占37.74%(20/53),真菌占3.77%(2/53)。主要病原体依次为大肠埃希菌20.75%(11/53)、金黄色葡萄球菌18.87%(10/53)、肺炎克雷伯菌13.21%(7/53)、鲍曼不动杆菌11.32%(6/53)及凝固酶阴性葡萄球菌9.43%(5/53)。ESBLs阳性率为42.11%,碳青霉烯耐药菌占15.79%,MRSA检出率为30.00%。感染组Treg比例(8.62%±1.87%vs 5.41%±1.53%,P<0.01)、PLR(189.36±54.22 vs 133.74±46.15,P<0.01)、MPV(10.91±1.27 vs 9.84±1.18 fL,P<0.01)及PDW(15.22±2.41 vs 13.67±2.12,P<0.01)均显著高于非感染组。Logistic回归分析显示，术中出血量>400 mL(OR=2.47,95%CI:1.21～5.06,P=0.014)、Treg升高(OR=3.65,95%CI:1.98～6.73,P<0.01)及PLR>170(Or=2.82,95%CI:1.43～5.59,P<0.01)为术后感染的独立危险因素。耐药菌感染者Treg水平明显高于非耐药菌感染者[9.27%±1.62%vs 7.94%±1.75%,P=0.018],PLR亦显著升高(203.48±58.17 vs 171.22±49.35,P=0.021)。Treg与PLR呈正相关(r=0.436,P<0.01),与病原菌耐药等级呈正相关(r=0.392,P<0.01),并随感染严重程度递增(P<0.01)。结论 宫颈癌术后感染以革兰阴性菌为主，常见病原体包括大肠埃希菌、金黄色葡萄球菌及肺炎克雷伯菌，ESBLs及MRSA耐药率较高。Treg及血小板反应指标(PLR、MPV、PDW)在感染患者中显著升高，提示Treg活化可能参与术后免疫抑制与感染易感过程，并与耐药菌感染密切相关。更多还原

【Abstract】 Objective To investigate the distribution of causative pathogens and antimicrobial resistance profiles in postoperative infections among patients undergoing surgery for cervical cancer, and to evaluate the associations of regulatory T cell(Treg) levels and platelet response indices with postoperative infection occurrence and drug-resistant infections, thereby providing evidence for infection prevention and immune monitoring after cervical cancer surgery. Methods A prospective observational study was conducted including 302 patients with cervical cancer who underwent radical surgery at our institution between March and September 2023. According to standardized diagnostic criteria for infection within 30 days postoperatively, patients were categorized into an infection group(n=47) and a non-infection group(n=255). Peripheral blood samples were collected 48 h after surgery to determine the proportion of Tregs by flow cytometry and platelet-related parameters, including the platelet-to-lymphocyte ratio(PLR),mean platelet volume(MPV),platelet distribution width(PDW),and plateletcrit(PCT). In the infection group, surgical site secretions, pelvic drainage fluid, urine, and blood specimens were obtained for microbiological culture and antimicrobial susceptibility testing. Logistic regression analysis was performed to identify independent risk factors for postoperative infection. Spearman correlation analysis was used to assess the relationships between Treg levels, platelet indices, antimicrobial resistance grades, and infection severity. Results The overall incidence of postoperative infection was 15.56%(47/302),with a microbiological positivity rate of 82.98%(39/47). A total of 53 pathogenic isolates were identified. Gram-negative bacteria accounted for 58.49%(31/53),Gram-positive bacteria for 37.74%(20/53),and fungi for 3.77%(2/53). The most common pathogens were Escherichia coli(20.75%,11/53),Staphylococcus aureus(18.87%,10/53),Klebsiella pneumoniae(13.21%,7/53),Acinetobacter baumannii(11.32%,6/53),and coagulase-negative staphylococci(9.43%,5/53). The prevalence of ESBL-producing organisms was 42.11%,carbapenem-resistant strains accounted for 15.79%,and the detection rate of MRSA was 30.00%. Compared with the non-infection group, the infection group exhibited significantly higher Treg proportions(8.62%±1.87% vs. 5.41%±1.53%,P<0.01),PLR(189.36±54.22 vs. 133.74±46.15,P<0.01),MPV(10.91±1.27 vs. 9.84±1.18 fL,P<0.01),and PDW(15.22±2.41 vs. 13.67±2.12,P<0.01). Multivariate logistic regression identified intraoperative blood loss >400 mL(OR=2.47,95% CI:1.21-5.06,P=0.014),elevated Treg levels(OR=3.65,95% CI:1.98-6.73,P<0.01),and PLR >170(OR=2.82,95% CI:1.43-5.59,P<0.01) as independent risk factors for postoperative infection. Patients with drug-resistant infections had significantly higher Treg levels than those with non-resistant infections(9.27%±1.62% vs. 7.94%±1.75%,P=0.018),accompanied by a marked increase in PLR(203.48±58.17 vs. 171.22±49.35,P=0.021). Treg levels were positively correlated with PLR(r=0.436,P<0.01) and antimicrobial resistance grade(r=0.392,P<0.01),and increased progressively with infection severity(P<0.01). Conclusion Postoperative infections following cervical cancer surgery are predominantly caused by Gram-negative bacteria, with E. coli,S. aureus, and K. pneumoniae being the most frequently isolated pathogens, and relatively high rates of ESBL production and MRSA detection. Elevated Treg levels and platelet response indices(PLR,MPV,and PDW) are strongly associated with postoperative infection and drug-resistant pathogens, suggesting that Treg activation may contribute to postoperative immunosuppression and increased susceptibility to infection. These findings support the potential value of combined immune and hematologic monitoring in the early identification and prevention of postoperative infectious complications.更多还原