Abstract: Objective To study the changes of Chemokines regulated by (thymus activation regulated chemokines,TARC) and β-defensin-3 in patients with postoperative pulmonary infection after intracranial aneurysm and their prognostic value.Methods A total of 120 patients with intracranial aneurysm who underwent neurosurgery in our hospital from January 2016 to January 2022 were selected.Referring to the “Diagnostic Criteria for Nosocomial Infections”,patients with postoperative pulmonary infection were divided into infection group with a total of 70 cases,and patients without pulmonary infection were divided into non-infection group with a total of 50 cases.The disease severity of the patients was scored with reference to the clinical lung infection score.The deep sputum of patients with suspected pulmonary infection was sampled within 3 days after operation,and cultured for 72 hours after inoculation in culture medium.Microscan WalkAway96 was used to identify bacterial species.The peripheral venous blood of the patients was collected within 3 days after operation,and the serum levels of β-defensin-3,TARC and interleukin-6 (IL-6) were detected by enzyme-linked immunosorbent assay.The levels of calcitonin (Procalcitonin,PCT) and C-reactive protein (CRP) in serum were detected by an automatic biochemical analyzer.The efficacy evaluation after 1 week of treatment mainly refers to the “Guidelines for Clinical Application of Antibacterial Drugs”.Results A total of 72 pathogenic bacteria were cultured in 70 patients in the infection group,including 49 gram-negative bacteria,accounting for 616.67%,24 gram-positive bacteria,accounting for 33.33%,.The expression levels of TARC,IL-6,PCT and CRP in the infection group were higher than those in the non-infection group (P＜0.05),and the expression level of β-defensin-3 in the infection group was lower than that in the non-infection group (P＜0.05).<0.05),and the higher the infection degree of the patients in the infection group,the higher the expression levels of TARC,IL-6,PCT and CRP in the patients (P＜0.05),the lower the expression levels of β-defensin-3 in the patients (P＜0.05).According to the prognosis of patients,the 70 patients in the infection group were divided into 22 patients in the worsening group and 48 patients in the improvement group.After 7 days of treatment,the expression levels of TARC,IL-6,PCT and CRP in the patients in the improvement group were higher than those in the patients in the worsening group.Low (P＜0.05),the expression level of β-defensin-3 in the improved group was higher than that in the worsening group (P＜0.05).After ROC curve analysis,the predictive areas under the curve of β-defensin-3,TARC,IL-6,PCT and CRP expression levels for postoperative pulmonary infection after intracranial aneurysm were 0.763,0.813,0.812,0.804 and 0.804,respectively.0.832.Conclusion Patients with postoperative pulmonary infection after intracranial aneurysm are mostly infected with Gram-negative bacteria,and the levels of TARC and β-defensin-3 can reflect the severity of infection to a certain extent,which has a certain clinical value.

Key words: Intracranial aneurysm, Pulmonary infection, β-defensin-3, TARC

摘要： 目的 研究确认颅内动脉瘤术后肺部感染患者机体胸腺活化调节的趋化因子(thymus activation regulated chemokines,TARC)和β-防御素-3变化以及其对患者预后的价值。方法 选择2016年1月到2022年1月到我院进行神经外科进行手术治疗的颅内动脉瘤患者120例。参考《医院感染诊断标准》,患者术后出现肺部感染分为感染组,共70例,未出现肺部感染患者分为非感染组,共50例。参考临床肺部感染评分对患者疾病严重程度进行评分。术后3天内对疑似肺部感染患者深部痰取样,在培养基中接种后培养72 h,应用Microscan WalkAway96鉴别菌种。术后3天内收集患者外周静脉血,应用酶联免疫吸附法对血清中β-防御素-3、TARC和白介素-6(IL-6)水平进行检测。应用全自动生化分析仪对血清中降钙素(Procalcitonin,PCT)和C-反应蛋白(C reactive protein,CRP)水平进行检测。治疗1周后疗效评价主要参考《抗菌药物临床应用指导原则》。结果 在70例感染组患者中共培养出72株病原菌,其中48株革兰氏阴性菌,占比66.67%,24株革兰阳性菌,占比33.33%,感染组患者的TARC、IL-6、PCT和CRP表达水平均相对于非感染组患者高(P＜0.05),感染组患者的β-防御素-3表达水平相对于非感染组患者低(P＜0.05),而且感染组患者的感染程度越高,患者的TARC、IL-6、PCT和CRP表达水平呈升高趋势(P＜0.05),患者的β-防御素-3表达水平呈降低趋势(P＜0.05)。依据患者预后情况将70例感染组患者分为22例恶化组患者和48例好转组,经过7日治疗后,好转组患者的TARC、IL-6、PCT和CRP表达水平均相对于恶化组患者低(P＜0.05),好转组患者的β-防御素-3表达水平相对于的恶化组患者高(P＜0.05)。经过ROC曲线分析,患者β-防御素-3、TARC、IL-6、PCT和CRP表达水平对颅内动脉瘤术后出现肺部感染的预测曲线下面积分别为0.763、0.813、0.812、0.804和0.832。结论 颅内动脉瘤术后肺部感染患者多感染革兰氏阴性菌,机体TARC和β-防御素-3水平能够在一定程度上反映患者感染的严重程度,具有一定的临床推广价值。

关键词: 颅内动脉瘤, 肺部感染, β-防御素-3, TARC