摘要
目的探讨血清内皮细胞特异性分子-1(ESM-1)、γ-干扰素(IFN-γ)、白细胞介素-1β(IL-1β)及IL-8对急性呼吸窘迫综合征(ARDS)合并肺部感染患者预后的预测价值.方法回顾性选取2018年3月-2020年2月于四川省成都市第四人民医院住院治疗的200例ARDS患者作为研究对象,检测患者入院后血清ESM-1、IFN-γ、IL-1β及IL-8水平,并依据是否合并肺部感染划分为感染组(n=108)和非感染组(n=92),检测感染组患者病原菌情况,进行药敏试验并对药敏情况进行统计;根据患者入院28 d时生存情况将ARDS患者划分为生存组(n=96)和死亡组(n=104),采用受试者工作特征(ROC)曲线分析血清ESM-1、IFN-γ、IL-1β及IL-8对ARDS患者发生肺部感染和预后的预测价值.结果ARDS合并肺部感染患者共培养分离病原菌165株,其中革兰阴性菌106株占64.24%,以肺炎克雷伯菌和大肠埃希菌为主;革兰阳性菌59株占35.76%,以金黄色葡萄球菌为主;其中肺炎克雷伯菌对头孢曲松、头孢唑林、氨苄西林舒巴坦耐药率>45%;大肠埃希菌对氨苄西林、环丙沙星以及头孢唑林耐药率>65%;金黄色葡萄球菌对苯唑西林、克林霉素以及磺胺甲噁唑/甲氧苄啶耐药率>70%;感染组患者血清ESM-1、IL-8、IL-1β均高于非感染组(P<0.05),IFN-γ低于非感染组(P<0.05);死亡组患者血清ESM-1、IL-8、IL-1β均高于生存组(P<0.05),IFN-γ低于生存组(P<0.05);血清ESM-1、IFN-γ、IL-1β及IL-8联合预测ARDS患者肺部感染发生和死亡的曲线下面积(AUC)均高于四项指标单独预测(P<0.05).结论造成ARDS患者肺部感染的病原菌主要以肺炎克雷伯菌、大肠埃希菌以及金黄色葡萄球菌为主,且致病菌的耐药情况较严峻;ESM-1、IFN-γ、IL-1β及IL-8联合检测对评估ARDS并发肺部感染和预后有较高价值.
OBJECTIVE To investigate the predictive value of serum endothelial cell specific molecule-1(ESM-1),gamma-interferon(IFN-γ),interleukin-1β(IL-1β)and interleukin-8(IL-8)for the prognosis of patients with acute respiratory distress syndrome(ARDS)complicated with pulmonary infection.METHODS Totally 200 patients with ARDS hospitalized in Chengdu Fourth People's Hospital,Sichuan Province from Mar.2018 to Feb.2020 were retrospectively selected as the study subjects,the serum levels of ESM-1,IFN-γ,IL-1βand IL-8 of the patients were measured after admission,and the patients were divided into infected group(n=108)and non-infected group(n=92)according to whether they were combined with pulmonary infection.The pathogenic bacteria of patients in the infected group were detected,and drug susceptibility test was conducted and drug susceptibility was statistically analyzed.The patients with ARDS were divided into survival group(n=96)and death group(n=104)according to their survival conditions at 28 days after admission.The predictive value of serum ESM-1,IFN-γ,IL-1βand IL-8 for pulmonary infection and prognosis in ARDS patients was analyzed by receiver operating characteristic(ROC)curve.RESULTS A total of 165 pathogenic bacteria strains were isolated from ARDS patients combined with pulmonary infection,of which 106 strains of Gram-negative bacteria accounted for 64.24%,mainly Klebsiella pneumoniae and Escherichia coli.59 strains of gram-positive bacteria accounted for 35.76%,mainly Staphylococcus aureus;The resistance rate of Klebsiella pneumoniae to ceftriaxone,cefzolin,ampicillin and sulbactam was more than 45%.The resistance rate of Escherichia coli to ampicillin,ciprofloxacin and cefazolin was>65%;The resistance rate of Staphylococcus aureus to benzoxicillin,clindamycin and sulfamethoxazole/trimethoprim was more than 70%.Serum ESM-1,IL-8 and IL-1βin infected group were higher than those in non-infected group(P<0.05),while IFN-was lower than that in non-infected group(P<0.05).Serum ESM-1,IL-8 and IL-1βin death group
作者
杜静
赵华昌
李小燕
卿刚
刘新
DU Jing;ZHAO Hua-chang;LI Xiao-yan;QING Gang;LIU Xin(Chengdu Fourth People's Hospital,Chengdu,Sichuan 610036,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第19期2886-2890,共5页
Chinese Journal of Nosocomiology
基金
成都市第四人民医院科研基金资助项目(2016021)。
