摘要
目的 :分析长期住院高龄患者医院获得性肺炎(hospital-acquired pneumonia,HAP)的病原学特点,并探讨早期相关炎症指标血清水平在评估其预后中的价值。方法:选择2017年4月至2019年4月本院老年科住院的高龄(≥80岁)且诊断为HAP的患者42例,进行痰涂片及痰培养+药敏试验,并在确诊HAP 24 h内进行血清C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)及白介素-6(interleukin-6,IL-6)水平等检测,观察病情进展及28 d归因病死率,分析早期相关炎症指标与HAP预后的关系。结果:在42例高龄HAP患者中共检出病原菌67株。其中革兰阴性(G-)菌占73.1%,产超广谱β-内酰胺酶(extended-spectrumβ-lactamases,ESBLs)G-杆菌的检出率为81.6%,产ESBLs肺炎克雷伯菌和铜绿假单胞菌的检出率分别为94.4%和69.2%。确诊14 d内需要接受机械通气者26例(61.9%),28 d内归因死亡12例(28.6%)。早期血清CRP水平无需机械通气患者[(25.2±18.0) mg/L]、需要接受机械通气患者[(26.5±25.5) mg/L]及死亡患者[(39.5±38.1) mg/L]之间差异无统计学意义。死亡患者早期血清PCT水平明显高于无需机械通气患者[(0.67±0.34)μg/L比(0.21±0.17)μg/L,P<0.05]。早期血清IL-6水平需要接受机械通气患者明显高于无需机械通气患者[(14.4±8.5) ng/L比(5.4±2.6) ng/L,P<0.01],死亡患者亦明显高于无需机械通气患者[(17.2±9.0) ng/L比(5.4±2.6) ng/L,P=0.02]。此外,早期血清PCT和IL-6水平与28 d归因死亡率呈正相关(r分别为0.585和0.636,均P<0.001)。结论:早期血清PCT及IL-6水平与HAP不良预后明显相关。在高龄长期住院人群中联合相关炎症指标检测可能有利于早期评估HAP的预后,指导临床医护人员及时规划诊治及监护方案。
Objective To investigate microbial etiologies of hospital-acquired pneumonia(HAP)among long-term hospitalized elderly patients and to evaluate early inflammatory markers in prognosis assessment of HAP.Methods A total of 42 elderly patients(≥80 years old)with HAP were recruited from April 2017 through April 2019,and the sputum smear and culture along with drug resistance test were performed.Serum C-reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6)levels were determined within 24 h of HAP diagnosis.The progression of the disease was followed,and the relationship between the early inflammation markers and prognosis of HAP was analyzed.Results Of the 67 pathogenic bacteria strains isolated,Gram-negative(G-)bacteria and extended-spectrumβ-lactamases(ESBLs)-producing G-bacteria presented in 73.1%and 81.6%of patients respectively.The Klebsiella pneumoniae and Pseudomonas aeruginosa were of the highest infection rates(94.4%and 69.2%)among ESBLs producing bacteria.61.9%of the patients need mechanical ventilation(MV)within 14 d of diagnosis;and the attributed mortality was 28.6%within 28 d.There was no difference of serum CRP among fatal cases(39.5±38.1)mg/L and patients with(26.5±25.5)mg/L and without MV(25.2±18.0)mg/L.The serum level of PCT in the early stage of fatal cases was significantly higher than that in patients without MV((0.67±0.34)μg/L vs.(0.21±0.17)μg/L,P<0.05).The serum level of IL-6 in early stage of fatal cases and patients on MV was significantly higher than that in patients without mechanical ventilation[(17.2±9.0)and(14.4±8.5)ng/L vs.(5.4±2.6)ng/L,P<0.02 and<0.01)The IL-6 and PCT level upon diagnosis were positively correlated with attributed mortality with 28 d.Conclusions Antibiotic resistance bacteria are of high prevalence in HAP patients.The level of early inflammation markers upon diagnosis,such as PCT and IL-6,are significantly associated with poor prognosis of HAP,and thus of importance in prognosis assessment of long-term hospitalized elderly patients with HAP.
作者
赵婷
陆运涛
朱迎钢
ZHAO Ting;LU Yuntao;ZHU Yinggang(Department of Pulmonary and Critical Care Medicine,Huadong Hospital,Fudan University,Shanghai 200040,China)
出处
《内科理论与实践》
2019年第4期225-229,共5页
Journal of Internal Medicine Concepts & Practice
基金
上海市卫生计生系统优秀青年医学人才培养计划(项目编号:2017YQ081)
关键词
高龄
医院获得性肺炎
耐药病原菌
白介素-6
降钙素原
Advanced aged
Hospital acquired pneumonia
Drug resistant pathogen
Interleukin-6
Procalcitonin
