摘要
目的 探讨泛耐药革兰阴性菌(XDR-GNB)感染脓毒症患者血清内毒素、降钙素原(PCT)、B型利钠肽(BNP)水平及其与预后的关系。方法 回顾性收集2019年10月-2022年10月海南省万宁市人民医院收治的258例XDR-GNB感染脓毒症患者资料,根据28 d病死情况将其分为存活组(n=166)和死亡组(n=92),对两组血清内毒素、PCT、BNP及序贯器官衰竭估计评分(SOFA)、急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分进行比较,应用受试者工作特征(ROC)曲线分析上述指标对患者预后评估的临床价值。结果 死亡组血清内毒素、PCT、BNP、SOFA评分、APACHE Ⅱ评分分别为(26.32±3.34)pg/mL、(5.93±1.21)ng/mL、(368.49±65.28)pg/mL、(14.35±3.27)分、(33.56±5.71)分,均高于存活组的(16.57±2.71)pg/mL、(3.68±0.91)ng/mL、(176.35±56.30)pg/mL、(9.42±3.04)分、(26.20±4.18)分,差异均有统计学意义(t=23.244、15.304、22.774、11.233、10.726,P均<0.05)。Logistic回归分析显示血清内毒素(OR=1.684,95%CI:1.077~2.632)、PCT(OR=5.737,95%CI:1.080~30.475)、BNP(OR=1.033,95%CI:1.001~1.065)及APACHE Ⅱ评分(OR=1.327,95%CI:1.005~1.753)均为XDR-GNB感染脓毒症患者28 d死亡的危险因素(P均<0.05)。血清内毒素、PCT、BNP及APACHE Ⅱ评分预测XDR-GNB感染脓毒症患者28 d死亡的曲线下面积(AUC)分别为0.869、0.883、0.921、0.885(P均<0.01)。血清内毒素、PCT、BNP分别与APACHE Ⅱ评分成正相关(r=0.394、0.415、0.463,P均<0.001)。结论 血清内毒素、PCT、BNP均能够较好地预测XDR-GNB感染脓毒症患者的预后情况,并且与APACHE Ⅱ评分相关,可一定程度反映患者病情。
Objective To explore the levels of serum endotoxin,procalcitonin(PCT) and B-type natriuretic peptide(BNP)and their relationship with prognosis in patients with extensively drug resistant Gram-negative bacteria(XDR-GNB)infection and sepsis.Methods A retrospective collection was performed on the data of patients with XDR-GNB infection and sepsis admitted to the People ' s Hospital of Wanning between October 2019 and October 2022.According to 28 d prognosis,they were divided into survival group(n=166)and death group(n=92).The levels of serum endotoxin,PCT and BNP,scores of sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)were compared between the two groups,and clinical evaluation value of the above indexes for prognosis was analyzed by receiver operating characteristic(ROC)curves.Results The levels of serum endotoxin,PCT,BNP,SOFA,APACHE Ⅱ were in the death group were(26.32±3.34)pg/mL,(5.93±1.21)ng/mL,(368.49±65.28)pg/mL,(14.35±3.27)score,(33.56±5.71)score,which were lower than that in the survival group[(16.57±2.71)pg/mL,(3.68±0.91)ng/mL,(176.35 ± 56.30)pg/mL,(9.42±3.04)score,(26.20±4.18)score],the differences were statistically significant(t=23.244,15.304,22.774,11.233,10.726,all P<0.05).Logistic regression analysis showed that serum endotoxin(OR=1.684,95%CI:1.077-2.632),PCT(OR=5.737,95%CI:1.080-30.475),BNP(OR=1.033,95%CI:1.001-1.065)and APACHE Ⅱ score(OR=1.327,95%CI:1.005-1.753)were all risk factors of death(all P<0.05).Area under curve(AUC)values of serum endotoxin,PCT,BNP and APACHE Ⅱ score for predicting 28 d death were 0.869,0.883,0.921 and 0.885,respectively(all P<0.01).The levels of serum endotoxin,PCT and BNP were positively correlated with APACHE Ⅱ score(r=0.394,0.415,0.463;all P<0.001).Conclusion Serum endotoxin,PCT and BNP could be used as indicators to predict prognosis of patients with XDR-GNB infection and sepsis,which were correlated with APACHE Ⅱ score and could reflect patients' condition to a certain extent.
作者
叶宝
周琮
占英妹
邓超
YE Bao;ZHOU Cong;ZHAN Yingmei;DENG Chao(Department of Laboratory,People's Hospital of Wanning,Wanning,Hainan 571500,China;Department of Clinical Laboratory,Qionghai People's Hospital,Qionghai,Hainan 571400,China;Department of Critical Care Medicine,Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou,Hainan 570208,China)
出处
《热带医学杂志》
CAS
2024年第3期413-417,共5页
Journal of Tropical Medicine
基金
海南省重点研发计划任务(ZDYFXGFY20200)。
关键词
泛耐药
革兰阴性菌
脓毒症
内毒素
降钙素原
B型利钠肽
预后
Extensively drug resistant
Gram-negative bacteria
Sepsis
Endotoxin
Procalcitonin
B-type natriuretic peptide
Prognosis
