The Changes Of IL-17?IL-10 In Bronchoalveolar Lavage Fluid With Neonatal Ventilator-Associated Pneumonia And Its Clinical Research

BackgroundWith the development of advanced life support technology for neonates,the success rate of emergency rescue for critically ill newborns is increasing.Mechanical ventilation has become more and more widely used in the treatment of severe respiratory diseases in newborns.However,ventilator-associated Pneumonia?VAP?is easily induced in neonates,especially in preterm infants with impaired immune function,clinical operations on the respiratory microenvironment,and disruption of the respiratory mucosal barrier.VAP severely affects the course and prognosis of patients.Therefore,it is of great clinical significance to thoroughly investigate the mechanism of VAP.In recent years,a large number of studies have found that inflammatory mediators play an important role.Reported in the literature^[1]:The level of inflammatory mediators in the serum of patients with VAP will change with the performance of VAP in the body,and is related to the treatment and prognosis of VAP;interleukin refers to the interaction between white blood cells or immune cells.Lymphokines,which transmit information,activate and regulate immune cells,mediate T,B cell activation,proliferation,differentiation and play an important role in the inflammatory response.The interleukin family not only participates in cellular immunity but also participates in humoral immune regulation.Interleukin-10?IL-10?is an endogenous anti-inflammatory cytokine,and interleukin-17?IL-17?is secreted by inflammatory stimuli of the body's T cells.When the body undergoes an inflammatory reaction By secreting interleukin 17,neutrophils are collected in the airways of the body.ObjectiveTo explore the clinical significance of IL-17 and IL-10 in the process of inflammatory reaction in children with VAP,and to detect the changes of IL-17 and IL-10 expression in bronchoalveolar lavage fluid in children with VAP.Methods200 cases were randomly selected with mechanical ventilation in PuYang Maternal and child health hospital.neonatal intensive care unit sinceJanuary 2015 to July 2017.According to whether or not they were combined with VAP,they were divided into VAP combination non-VAP group,54 of which were VAP group.There were 34 cases of neonatal respiratory distress syndrome,6 cases of asphyxia,4 cases of meconium aspiration syndrome,8 cases of apnea,2 cases of pulmonary hemorrhage.In the non-VAP group,there were 146 cases,108 cases of primary respiratory neonatal respiratory distress syndrome,10 cases of asphyxia,6 cases of meconium aspiration syndrome,14 cases of apnea,6 cases of pulmonary hemorrhage,and 2 cases of hemorrhoids.Record the patient's general condition:including birth time,birth weight,birth gestational age,pulmonary surfactant,application of pulmonary surfactant?PS?,prenatal glucocorticoid application,mechanical ventilation?MV?The bronchoalveolar lavage fluid?BALF?was administered by bronchoalveolar lavage?BALF?at the time of 24 hours,48 hours and 96 hours after the application of MV.Bacterial cultures were performed and IL-17 and IL-10 were detected by enzyme-linked immunosorbent assay.SPSS19 software was used for statistical analysis.Result1.There was no statistical difference between the two groups??²=2.08;P=0.813?.There was no statistically significant difference between the general conditions of admission?P>0.05?.2.Compared with the two groups,the oxygen time of the VAP group was significantly increased?t=2.29?P<0.05?.The MV time was significantly extended?t=2.83?P<0.05?.3.Sputum culture of children in VAP group was high in sputum:32 strains of klebsiella pneumoniae?55%?.6 strains of acinetobacter baumannii?10%?.4 strains of enterobacter cloacae?6.8%?.4 strains of pseudomonas aeruginosa?3.4%?.2 strains of escherichia coli?3.4%?,etc.4.VAP group:il-17 and il-10 were compared between groups of 24h BALF and 48h and 96h.P is less than 0.05;The comparison of 24h BALF level with 48h and 96h showed statistically significant difference.Compared with 96h,P is greater than 0.05,and the difference was not statistically significant.Non-vap groups:il-17 and il-10 were compared with 48h,96h,48h and 96hcompared to 24h BALF,and the P value was greater than 0.05,and the difference was not statistically significant.5.Compared with the two groups,the expression level of il-17 was treated in the VAP group in the MV treatment of 24h BALF?t=0.79;P>0.05?.the expression level of il-10?t=1.48;P>0.05?,the difference was not statistically significant;Compared with the two groups,the expression level of il-17 in the VAP group was increased in the treatment of48h and 96h BALF.P is less than 0.05;The expression level of il-10 increased;All P are less than 0.05.Conclusion1.During the development of VAP,the expression of IL-17 in the body gradually increased,and the expression of IL-10 gradually increased.Participate in the occurrence and development of VAP.2.The pathogenic microorganisms of VAP are mainly Klebsiella pneumoniae.VAP aggravates inflammation,increases MV treatment time and oxygen time.