摘要
目的分析血流感染脓毒症患者炎症因子水平的动态变化对病情严重程度及预后的预测价值,为临床疾病类型判断及临床治疗提供参考依据。方法选取2014年1月-2017年1月医院重症监护病房收治的血流感染脓毒症患者88例,根据患者血样细菌培养情况将其分为革兰阳性菌血流感染组与革兰阴性菌血流感染组,对两组患者24h内不同炎症因子[降钙素原(PCT)、C-反应蛋白(CRP)、内毒素等]的差异进行比较,并将其与APACHEⅡ评分的相关性进行分析。结果 88例脓毒症患者血培养共分离出病原菌88株,其中62株为革兰阴性菌,占70.5%;26株为革兰阳性菌,占29.5%;血清PCT、CRP及内毒素与APACHEⅡ评分均呈正相关,其中PCT与革兰阴性组相关性最高,CRP与革兰阳性组相关性最高;严重脓毒症组PCT、CRP及内毒素水平均高于脓毒症组患者(P<0.05);PCT、CRP及内毒素三项炎症因子指标预测患者革兰阴性严重脓毒症的截断值分别为2.27μg/L,76.82mg/L与13.79ng/L,预测革兰阳性菌血流感染脓毒症的截断值分别为1.51μg/L,93.22 mg/L与14.99ng/L,且两组的特异性、曲线下面积以及敏感性均较高。结论针对血流感染脓毒症患者,早期联合监测炎症因子PCT、CRP及内毒素水平具有较好的诊断预测价值,且其水平均与脓毒症病情严重程度呈正相关,可以作为临床上早期判断血流感染所致脓毒症及其病情严重程度的重要指标。
OBJECTIVE To analyze the value of dynamic changes of inflammatory factors in prediction of severity and prognosis of patients with bloodstream infections and sepsis so as to provide guidance for clinical diagnosis and treatment of diseases.METHODS A total of 88 patients with bloodstream infections and sepsis who were treated in intensive care units from Jan 2014 to Jan 2017 were enrolled in the study and divided into the gram-positive bacteria bloodstream infection group and the gram-negative bacteria bloodstream infection group according to the result of bacterial culture.The levels of 24-hour inflammatory factors,including procalcitonin（PCT）,C-reactive protein（CRP）and endotoxin,were compared between the two groups of patients,and the relationship with APACHEⅡscore was analyzed.RESULTS Totally 88 strains of pathogens were isolated from the 88 sepsis patients,62（70.5%）of which were gram-negative bacteria,and 26（29.5%）were gram-positive bacteria.The levels of serum PCT,CRP and endotoxin were positively correlated with the APACHEⅡ score,the PCT level showed the highest correlation with the gram-negative bacteria group,while the CRP level showed the highest correlation with the gram-positive bacteria group.The levels of PCT,CRP and endotoxin were significantly higher in the severe sepsis group than in the sepsis group（P〈0.05）.The cutoff values of PCT,CRP and endotoxin were respectively2.27μg/L,76.82 mg/L and 13.79 ng/L in prediction of severe sepsis caused by gram-negative bacteria and were respectively 1.51μg/L,93.22 mg/L and 14.99 ng/L in prediction of bloodstream infection sepsis caused by the gram-positive bacteria;the specificity,area under curve and sensitivity of the two groups were high.CONCLUSION Early joint monitoring of the inflammatory factors PCT,CRP and endotoxin levels has significant value in prediction and diagnosis of the patients with bloodstream infections and sepsis;the levels of the inflammatory factors are positively correlated with the severity of the sepsis,which
作者
刘英其
李春梅
叶晓燕
张静
刘延苏
LIU Ying-qi;LI Chun-mei;YE Xiao-yan;ZHANG Jing;LIU Yan-su(Second People＇s Hospital of Yiwu, Yiwu, Zhejiang 322002, Chin)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第10期1459-1462,共4页
Chinese Journal of Nosocomiology
基金
浙江省中西医结合学会科研基金资助项目(2013LYSX004)
关键词
血流感染
脓毒症
降钙素原
C-反应蛋白
内毒素
炎症因子
Bloodstream infection
Sepsis
Procalcitonin
C-reactive protein
Endotoxin
Inflammatory factor
