摘要
目的研究老年食管癌根治术(RREC)术后并发肺部感染(PI)的病原学特点及降钙素原(PCT)、C反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)水平变化。方法选取2018年7月—2021年6月空军军医大学第一附属医院治疗的老年RREC并发PI患者42例纳入PI组,选取同期于空军军医大学第一附属医院治疗的老年RREC未并发PI患者50例纳入非PI组,选取同期于空军军医大学第一附属医院行健康体检的正常人140例纳入对照组,对PI或怀疑PI患者进行病原学检测,检测3组血清PCT、CRP和TNF-α水平。分析PCT、CRP和TNF-α单独及联合诊断老年RREC术后并发PI的灵敏度、特异度。结果PI组共检测出59株病原菌,其中真菌4株、革兰阳性菌16株、革兰阴性菌39株。在所有病原菌中,检出率最高的为肺炎克雷伯菌(25.42%),检出率最低的为阴沟肠杆菌(1.69%)。金黄色葡萄球菌耐药性最强的前3位抗生素依次为青霉素(100.00%)、克林霉素(81.82%)、苯唑西林(72.73%)。肺炎克雷伯菌耐药性最强的前3位抗生素依次为氨苄西林(86.67%)、哌拉西林(53.33%)、头孢呋辛(40.00%);鲍曼不动杆菌耐药性最强的前3位抗生素依次为头孢唑林(100.00%)、头孢呋辛(91.67%)、氨苄西林(41.67%)。PI组血清PCT、CRP和TNF-α水平均高于非PI组、对照组,非PI组血清PCT、CRP和TNF-α水平均高于对照组(P<0.05)。PCT、CRP和TNF-α联合诊断老年RREC术后并发PI的灵敏度、特异度均高于PCT、CRP和TNF-α单独及两两联合诊断(P<0.05)。结论导致RREC并发PI的主要病原菌为革兰阴性菌,真菌检出率相对较低,检出率最高的前3种病原菌对不同抗生素均存在程度不同耐药。RREC并发PI患者血清PCT、CRP和TNF-α水平升高,且血清PCT、CRP和TNF-α联合诊断老年RREC并发PI患者具有较高的灵敏度、特异度,可应用于RREC并发PI的辅助诊断。
Objective To study the etiological characteristics of pulmonary infection(PI)and the changes of PCT,CRP and TNF-αlevels after radical resection of esophageal carcinoma(RREC)in elderly patients.Methods 42 elderly patients with RREC complicated with PI treated in First Affiliated Hospital of Air Force Military Medical University from July 2018 to June 2021 were included in the PI group,50 elderly patients with RREC without PI treated in the same hospital at the same time were included in the non-PI group,and 140 normal people who underwent physical examination in the same hospital and the same period were included in the control group.Etiological tests were performed on patients with PI or suspected PI.The levels of serum PCT,CRP and TNF-αof the three groups were detected.The sensitivity and specificity of PCT,CRP and TNF-αalone and in combination in the diagnosis of PI after RREC operation in the elderly patients were analyzed.Results A total of 59 strains of pathogenic bacteria were detected in PI group,including 4 strains of fungi,16 strains of Gram-positive bacteria and 39 strains of Gram-negative bacteria.Among all pathogenic bacteria,the highest detection rate was Klebsiella pneumoniae(25.42%),and the lowest detection rate was Enterobacter cloacae(1.69%).The top 3 antibiotics with the strongest resistance to Staphylococcus aureus were penicillin(100.00%),clindamycin(81.82%),and oxacillin(72.73%).The top three antibiotics with the strongest resistance to Klebsiella pneumoniae were ampicillin(86.67%),piperacillin(53.33%)and cefuroxime(40.00%).The top three antibiotics with the strongest resistance to Acinetobacter baumannii were cefazolin(100.00%),cefuroxime(91.67%)and ampicillin(41.67%).The levels of serum PCT,CRP and TNF-αof the PI group were higher than those of the non-PI group and control group,and the levels of serum PCT,CRP and TNF-αof the non-PI group were higher than those of the control group(P<0.05).The sensitivity and specificity of the combined diagnosis of PCT,CRP and TNF-αin elderly patient
作者
陈小云
郭建英
张瑶
张翠翠
Chen Xiaoyun;Guo Jianying;Zhang Yao;Zhang Cuicui(Medical Center For Soldiers,First Affiliated Hospital of Air Force Military Medical University,Xi'an,Shaanxi,710032,P.R.China;Outpatient Department,First Affiliated Hospital of Air Force Military Medical University,Xi'an,Shaanxi,710032,P.R.China)
出处
《老年医学与保健》
CAS
2021年第6期1173-1177,共5页
Geriatrics & Health Care
基金
陕西省重点研发计划项目(2018ZDXM-SF-061)。
关键词
老年
食管癌根治术
肺部感染
病原学特点
PCT
CRP
TNF-Α
elderly
radical resection of esophageal carcinoma
pulmonary infection
etiological characteristic
PCT
CRP
TNF-α
