老年患者有更严重的胆道感染：补体杀伤和肿瘤坏死因子α产生诱导的影响。

Elderly patients have more severe biliary infections: influence of complement-killing and induction of TNFalpha production.

作者信息

Stewart Lygia, Grifiss J McLeod, Jarvis Gary A, Way Lawrence W

机构信息

Department of Surgery, University of California, San Francisco, CA 94121, USA.

出版信息

Surgery. 2008 Jan;143(1):103-12. doi: 10.1016/j.surg.2007.06.035. Epub 2007 Dec 3.

DOI:10.1016/j.surg.2007.06.035

PMID:18154938

Abstract

BACKGROUND

Biliary bacteria are more common in elderly patients and cause more serious illnesses. The reasons for this are unclear. We noted previously that bacterial serum-sensitivity and induction of TNFalpha production in sera (iTNFsera) were associated with severe biliary infections. We examined the influence of age and these factors on illness severity.

METHODS

Three-hundred and forty patients were studied. Gallstones and bile were cultured. Illness was staged as none (no clinical infection or inflammation), SIRS (fever, leukocytosis), severe (cholangitis, abscess, empyema), or MODS (bacteremia, hypotension, organ dysfunction/failure). Bacterial serum-sensitivity and TNFalpha induction were measured. Younger (< 70 years) and elderly (> or = 70 years) patients were compared.

RESULTS

Biliary bacteria were more common in elderly (64% vs 41%, P < .0001). Among patients with biliary bacteria, the elderly had more serious illnesses: none: 44% younger, 19% elderly; SIRS: 16% younger, 22% elderly; severe: 22% younger, 21% elderly; MODS 18% younger, 38% elderly (P = .003). Bacteria from elderly patients induced more TNFalpha (580 vs 310 pg/ml, P = .023). In both groups, serum-sensitive bacteria caused infectious manifestations and induced abundant TNFalpha; however, serum-resistant bacteria from elderly usually (69%) caused infectious manifestations and abundant TNFalpha, while serum-resistant bacteria from younger patients rarely (8%) caused infectious manifestations and minimal TNFalpha. Elderly patients with high iTNFsera bacteria had more severe illnesses.

CONCLUSIONS

Biliary bacteria were more common in elderly patients and produced more serious illnesses. Many younger patients with biliary bacteria displayed no infectious manifestations. Elderly patients harbored more virulent bacteria, and had a heightened response to high iTNFsera bacteria, as well as bacteria largely tolerated by younger patients.

摘要

背景

胆道细菌在老年患者中更为常见，且会引发更严重的疾病。其原因尚不清楚。我们之前注意到细菌血清敏感性以及血清中肿瘤坏死因子α（TNFα）的诱导产生（iTNFsera）与严重胆道感染有关。我们研究了年龄以及这些因素对疾病严重程度的影响。

方法

对340例患者进行研究。对胆结石和胆汁进行培养。疾病分为无（无临床感染或炎症）、全身炎症反应综合征（SIRS，发热、白细胞增多）、严重（胆管炎、脓肿、脓胸）或多器官功能障碍综合征（MODS，菌血症、低血压、器官功能障碍/衰竭）。测量细菌血清敏感性和TNFα诱导情况。比较年轻（<70岁）和老年（≥70岁）患者。

结果

胆道细菌在老年患者中更为常见（64%对41%，P<.0001）。在有胆道细菌的患者中，老年患者的疾病更严重：无：年轻患者44%，老年患者19%；SIRS：年轻患者16%，老年患者22%；严重：年轻患者22%，老年患者21%；MODS：年轻患者18%，老年患者38%（P=.003）。老年患者的细菌诱导产生更多的TNFα（580对310 pg/ml，P=.023）。在两组中，血清敏感细菌都会引起感染表现并诱导产生大量TNFα；然而，老年患者的血清耐药细菌通常（69%）会引起感染表现和大量TNFα，而年轻患者的血清耐药细菌很少（8%）会引起感染表现且产生极少的TNFα。iTNFsera细菌水平高的老年患者疾病更严重。