摘要
目的探讨呼吸机相关性肺炎患者感染病原菌分布与中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)对预后的临床价值。方法选取2016年6月至2018年2月确诊并收治的呼吸机相关性肺炎(VAP)患者68例为观察组,根据VAP患者28 d的预后情况,分为生存组50例和死亡组18例。另选取同期接收呼吸机治疗但未发生VAP的患者30例为对照组。取VAP患者感染部位的脓性液体或痰液,分析感染患者的病原菌分布;抽取观察组插管时(T0)、确诊VAP后24 h(T1)及120 h(T2)静脉血,对照组血液采集时间同观察组一致,比较各组间NLR、PLR的差异,分析观察组患者NLR、PLR的相关性,并通过ROC分析VAP患者确诊时NLR、PLR对预后评估的价值。结果 68例患者标本中分离病原菌共358株,其中革兰阴性菌为VAP患者的主要病原菌共222株,占62.01%,其中铜绿假单胞菌(16.76%)比例最高,其次为鲍曼不动杆菌(12.85%);革兰阳性菌为124株,在VAP病原菌中占34.64%,以金黄色葡萄球菌(10.89%)和表皮葡萄球菌(8.94%)为主;真菌比例较低共检测出12株,占3.35%,主要为白色假丝酵母菌(2.23%)。观察组与对照组、生存组与死亡组在T0时刻NLR、PLR比较差异无统计学意义(P>0.05);相较于对照组,观察组在T1、T2时刻NLR与PLR明显较高,差异有统计学意义(P<0.05);与生存组相比,死亡组在T1、T2时刻NLR与PLR明显更高,差异有统计学意义(P<0.05)。VAP患者经Pearson相关性分析,VAP患者确诊时NLR与PLR呈明显的正相关关系(r=0.362,P=0.008)。VAP患者确诊时即T1时刻NLR的ROC曲线下面积为0.756,最佳临界值为2.580,敏感性为、特异性分别为71.2%,85.6%(P=0.015);在该时刻PLR的ROC曲线下面积为0.832,最佳临界值为186.320,敏感性为、特异性分别为79.54%,486.2%(P=0.028)。结论革兰阳性菌是VAP患者感染主要病原菌,NLR、PLR可作为VAP患者及时进行病情评估及预后判断的良好指标。
Objective To investigate the distribution of pathogenic bacteria in patients with ventilator-associated pneumonia(VAP) and the clinical value of NLR and PLR in prognosis evaluation.Methods A total of 68 patients with VAP who were diagnosed and treated in our hospital from June 2016 to February 2018 were enrolled as observation group.According to the prognosis of patients on 28 days,who were subdivided into survival case group(n=50) and death case group(n=18).At the same time, the other 30 patients,who received ventilator therapy,without suffering from VAP,were enrolled as control group.The purulent liquid or sputum in infection site of patients was taken to analyze the distribution of pathogenic bacteria,and the venous blood was taken from the patients in observation group at the time of T0 and 24 h(T1) and 120 h(T2) after VAP diagnosis.The differences of NLR and PLR were observed and compared among groups,moreover, the correlation between NLR and PLR in observation group was analyzed.The value of NLR and PLR in prognosis evaluation of patients was analyzed by ROC.Results A total of 358 strains of pathogenic bacteria were isolated from the 68 patients,in which, 222 strains of gram-negative bacteria were the main pathogenic bacteria of patients with VAP,accounting for 62.01%,of which, the proportion of pseudomonas aeruginosa(16.76%) was the highest,followed by acinetobacter baumannii(12.85%).The number of gram-positive bacterial strains was 124,accounting for 34.64% of the total VAP pathogens,with staphylococcus aureus(10.89%) and staphylococcus epidermidis(8.94%) as the main ones.A total of 12 strains of fungi were detected,accounting for 3.35%,and the majority of them were candida albicans(2.23%).There was no significant difference in NLR and PLR between the observation group and the control group,between survival group and death group at the time of T0(P>0.05).The NLR and PLR in observation group at T1 and T2 were significantly higher than those in control group(P<0.05),which in death case group were significan
作者
母前途
潘峰
唐蕾
MU Qiantu;PAN Feng;TANG Lei(No.958 Hospital of PLA,Chongqing,400020,China)
出处
《河北医药》
CAS
2019年第21期3265-3268,共4页
Hebei Medical Journal
