| Background&Objective:Perianal abscess and anal fistula are common and frequently-occurring diseases in The Department of Anorectal Surgical.Both of them are occur easily in young adults.Perianal abscess is easy to develop into anal fistula,and anal fistula is easy to recur,often requiring multiple operations.Although it is a benign disease,it has also become a thorny problem that anorectal surgeons often face.In this study,the distribution and drug resistance of pathogenic bacteria in patients with perianal abscess and anal fistula were analyzed,which provided a reference for guiding the rational use of antibiotics and reducing the production of drug-resistant strains.The expression and correlation of tumor necrosis factor-α(TNF-α)and interleukin-4(IL-4)in perianal abscess and anal fistula with different course of disease were further studied,and to investigate the role and significance of TNF-αand IL-4 in the occurrence and development of perianal abscess and anal fistula.Methods:The data of all patients with perianal abscess or anal fistula diagnosed pathologically from January 1,2017 to December 31,2017 in Hangzhou Clinical College of Anhui Medical University(Hangzhou third people’s Hospital)were collected retrospectively.They were divided into 4 groups:perianal abscess group,anal fistula course<3 months group,anal fistula course 3-6 months group,anal fistula course>6 months group.30 cases in each group were randomly selected according to the random number table method,and the clinical data of 120 cases of perianal abscess and anal fistula were obtained.Under aseptic operation,the pus or fistula secretions of patients were collected and sent to the laboratory of the hospital for bacterial culture and drug sensitivity test,and the results were analyzed.The corresponding paraffin specimens of 120 cases of perianal abscess wall and anal fistula were collected from the pathology department of the hospital.Immunohistochemical assay was used to detect the expression and distribution of TNF-αand IL-4 in abscess wall and fistula pathological specimens,and the difference of TNF-αand IL-4 expression in different bacterial infections was further analyzed.The correlation between the expression of TNF-αand IL-4 was analyzed..Results:1)Among the 120 bacterial specimens,bacterial growth was detected in 115cases,and a total of 145 pathogenic bacteria were isolated.The predominant pathogens are Escherichia coli and Klebsiella pneumonia.Escherichia coli showed high resistance to most antibiotics,while Klebsiella pneumoniae has a lower resistance rate.2)Immunohistochemistry revealed that the positive rates of TNF-αwere 80%,90%,83%,73%in perianal abscess group,anal fistula course(27)3 months group,3-6 months group,and(29)6 months group respectively.The difference of expression rate between groups was statistically significant(P(27)0.05).There was significant difference in the positive rate of TNF-αbetween the perianal abscess group and the 3-6 months group(P<0.05),there was no significant difference among the other groups(P>0.05);the positive rates of IL-4 were 80%,90%,83%,73%.The difference in rate was statistically significant(P(27)0.05).There was significant difference in the positive rate of IL-4 expression between the anal fistula<3 months group and the>6 months group(P<0 05),but there was no significant difference among the other groups(P>0 05).There was no significant difference between the positive expression of TNF-αand IL-4 and single bacteria infection(P>0 05).Further correlation analysis indicated that the expression of TNF-αwas positively correlated with IL-4(r_s=0.707,P(27)0.05).Conclusion:The main pathogenic bacteria of perianal abscess and anal fistula was Escherichia coli,The antibiotictreatment should depended on bacterial spectrum and drug sensitivity test results in order to reduce the drug resistance.The expression of both TNF-αand IL-4 were increasedand positively correlatedin perianal abscess and anal fistula,suggesting that they involved in the occurrence and development of perianal abscess and anal fistula.The anti-inflammatory effect of IL-4 in perianal abscess and anal fistula is not as significant as the pro-inflammatory effect of TNF-α. |
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