摘要
目的探讨老年急性心力衰竭患者住院肺部感染危险因素及利钠肽前体A基因(Natriuretic peptide precursor A,NPPA)多态性分析。方法选择海口市人民医院急诊科2018年6月-2019年9月收治的急性心衰患者120例作为研究对象,根据是否发生肺部感染分为感染组(n=39)和非感染组(n=81),通过电子病历调查的方式收集患者一般资料,采用多元Logistic回归法分析老年急性心力衰竭患者发生住院肺部感染危险因素;收集呼吸道标本,调查其肺部感染病原菌分布;通过聚合酶链式扩增反应及测序法得到NPPA基因型结果,分析其突变与炎症指标关系。结果多元Logistic回归分析结果表明,有吸烟史、合并COPD、住院时间>14 d、有接受侵入性操作史、心功能分级Ⅲ~Ⅳ级、CONUT评分>4分为老年急性心衰患者肺部感染的独立危险因素(P<0.05);39例感染患者共检出病原菌43株,其中革兰阴性菌28株占65.12%,革兰阳性菌13株占30.23%,真菌2株占4.65%,肺炎克雷伯菌、铜绿假单胞菌、肺炎链球菌、鲍氏不动杆菌检出率较高;感染组、非感染组rs5067基因型分布差异具有统计学意义(χ^(2)=2.090,P<0.001);感染组rs5067 CC、TC型低于非感染组,TT型高于非感染组;rs5067 TT型组CRP、PCT水平高于CC+TC型组(P<0.05)。结论老年急性心力衰竭患者住院肺部感染应注意其吸烟史、合并COPD、住院时间、接受侵入性操作、心功能分级、CONUT评分等因素,NPPA rs5067基因突变与该病易感性存在关联。
OBJECTIVE To investigate the risk factors of pulmonary infection in elderly hospitalized patients with acute heart failure and the polymorphism analysis of natriuretic peptide precursor A(NPPA) gene. METHODS Total of 120 patients with acute heart failure admitted to the emergency department of Haikou People’s Hospital from Jun. 2018 to Sep. 2019 were enrolled as the research subjects. According to whether lung infection occurred, they were divided into the infection group(39 cases) and non-infection group(81 cases). Patients’ general data were collected through electronic medical record survey, and multivariate logistic regression method was used to analyze the risk factors of hospitalized lung infection in elderly patients with acute heart failure. Respiratory tract specimens were collected to analyze the distribution of pathogenic bacteria in their lungs. The results of NPPA genotype were obtained by polymerase amplification reaction and sequencing method, and the relationship between its mutation and inflammation index was analyzed. RESULTS Multiple logistic regression analysis showed that history of smoking, COPD, length of hospital stay>14 days, history of invasive operation, cardiac function grade III to IV and CONUT score>4 were the independent risk factors of acute heart failure in elderly patients(P<0.05). A total of 43 pathogenic bacteria were detected in 39 infected patients, including 28 Gram-negative bacteria, accounting for 65.12%, 13 Gram-positive bacteria, accounting for 30.23%, and 2 fungi, accounting for 4.65%;Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Acinetobacter baumannii had a higher detection rate. The difference of rs5067 genotype distribution between the infected group and non-infected group was significant(χ^(2) =2.090, P<0.001);rs5067 CC and TC types in the infected group were significantly lower than that in the non-infected group and TT type was higher than that in the non-infected group. The CRP and PCT levels in the rs5067 TT group were signif
作者
关小容
付斌
郑永先
吴泽
GUAN Xiao-rong;FU Bin;ZHENG Yong-xian;WU Ze(Haikou Hospilal Affiliated to Xiangya Medical College of Central South University,Haikou,Hainan 570208,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第7期981-985,共5页
Chinese Journal of Nosocomiology
基金
海南省自然科学基金面上项目(318MS133)。
关键词
急性心力衰竭
肺部感染
危险因素
利钠肽前体A基因
多态性
Acute heart failure
Pulmonary infection
Risk factors
Natriuretic peptide precursor A gene
Polymorphism
