【作者】 赵有成；

【导师】 魏宏建； 段勇；

【作者基本信息】 昆明医学院 ， 麻醉学， 2004， 硕士

【摘要】 目的：应用多聚酶链反应(PCR)技术探讨病人血中细菌16SrRNA基因为临床准确认识重症合并感染提供科学依据。揭示血清白细胞介素6(IL-6)水平在重症合并感染与非感染者体内变化规律及意义。 方法：40例APACHEⅡ评分≥12分重症合并感染的病人，抽取其外周血，应用通用引物PCR法检测血中细菌16SrRNA基因、放射免疫分析法检测血清IL-6水平和血细菌培养。对PCR和血培养这两种检测细菌的结果进行比较。30例正常对照组检测其血中细菌16SrRNA基因和IL-6水平；30例重症非合并感染病人检测其血清IL-6水平。将重症合并感染组、重症非合并感染组和正常对照组的血清IL-6水平进行比较。同时将重症合并感染组的IL-6水平与病人的预后、APACHEⅡ评分作相关性分析。 结果：40例重症合并感染的病人中PCR阳性的13人，阳性率为32.5％(13／40)。血培养阳性的6人，阳性率为15％(6／40)。血培养阳性的PCR全部为阳性。重症合并感染组血清IL-6水平均数为152.02±55.77 pg／mL，重症非合并感染病人的血清IL-6水平均数为130.98±50.72pg／mL，二者均升高，但该两组的血清IL-6水平比较无显著性差异(p＞0.05)，它们与正常对照组(IL-6为85.79±30.96pg／mL)比较均有显著性差异(p＜0.01)。重症合并感染组血清IL-6水平与病人的预后呈正相关(r=0.667，p=0.000)，与APACHEⅡ评分呈正相关(r=0.485，p=0.002)，与白细胞数均值(14.2±5.7×10~9／L)呈正相关(r=0.371，p＜0.05)。40例感染患者中有20例死亡，他们的血清IL-6水平(186.20±48.74pg／mL)较生存病例(117.84±39.36pg／mL)高(t=4.880，p=0.000)。30例重症非合并感染病人的血清IL-6水平与APACHEⅡ评分呈正相关(r=0.524，p=0.003)。 结论：1、用PCR方法检测重症合并感染病人血中细菌16SrRNA基因具有灵敏、快速、不受使用抗生素的影响，与临床诊断吻合度高等优点，弥补与丰富了细菌学检查方法，为准确认识和救治重症合并感染提供科学依据。2、应用本实验方法可见重症无论合并感染与否血清IL-6水平均升高，其升高反应了损伤的严重程度，与预后有较好的相关性。更多还原

【Abstract】 Objective: To explore scientific basis for accurate clinical cognition of serious patients with infections by detecting bacterial 16SrRNA gene in plasm with Polymerase chain reaction (PCR),and reveal regularity and significance of serum interleukin-6 (IL-6) levels in serious patients with and without infections. Materials and Methods:APACHEII score over 12 was defined as serious disease. 40 serious patients with infections were admitted, drawn their peripheral blood to detect 16SrRNA gene with PCR and IL-6 levels with radio-immunity analysis assay, and perform bacterial blood culture simultaneously. PCR was compared with blood culture. The 16SrRNA gene and IL-6 levels were detected in 30 normal controls.The IL-6 levels were measured in another 30 serious patients without infections. Thencompared the IL-6 levels among the normal control group and the serious patientsgroups with and without infections each other. At the same time, in the seriouspatients with infections, the correlation between the IL-6 levels and the prognosis and that between the IL-6 levels and the APACHEII score were investigated. Results:Of the 40 serious patients with infections , 13 patients were positive with PCR, and the rate was 32.5 % (13 /40) .6 persons were positive with blood culture, and 15 % (6/40) .The persons with positive blood culture were all PCR positive. In the serious patients with and without infections groups and the normal control group, the averages of IL-6 levels were 152.02 + 55.77 pg/mL ,130.98?50.72pg/mL and 85. 79?0.96pg/mL , respectively. Both of the serious patients groups were significantly higher than the normal control group (p<0. 01) , but there were no significant differences between the serious patients groups (p > 0.05) .In the group of serious patients with infections, there was a positive correlation between the IL-6 levels and the prognosis (r=0.667, p=0. 000) ,that between the IL-6 levels and APACHEII score (r=0.485,p=0.002), and that between the IL-6 levels and the average of white blood cell count (14. 2?. 7X109/L) (r=0. 371, p<0. 05) , too. Among 40 serious patients with infections, 20 patients were dead, and their IL-6 levels (186.20 + 48.74pg/mL) were higher than those(117.84 + 39. 36pg/mL) of the survivors(t=4. 880, p=0. 000). In 30 serious patients without infections, there was a positive correlation between the IL-6 levels and APACHEII score (r=0. 524, p=0. 003) .Cone I usions:1. PCR could detect bacterial 16SrRNA gene in plasm in the serious patients with infections.lt was sensitive, rapid, and uninfluenced by antibiotics. What’s more, the goodness of fit with clinical diagnosis was high, which made up the method in bacteriology and provided a scientific basis for accurate cognition and treatment of serious patients with infections. 2. The IL-6 levels were elevated between the serious patients with and without infections. It appeared to reflect the severity of disease, and there was a good correlation between the IL-6 levels and prognosis.更多还原