[1]贾向红,刘亚博,周志敏.呼吸机相关性肺炎患者病原菌分布及血清降钙素原和白细胞介素-6水平对其预后的预测价值[J].新乡医学院学报,2021,38(12):1155-1159.[doi:10.7683/xxyxyxb.2021.12.010]
　JIA Xianghong,LIU Yabo,ZHOU Zhimin.Distribution of pathogenic bacteria and the value of serum procalcitonin and interleukin-6 levels in predicting the prognosis of patients with ventilator-associated pneumonia[J].Journal of Xinxiang Medical University,2021,38(12):1155-1159.[doi:10.7683/xxyxyxb.2021.12.010]
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呼吸机相关性肺炎患者病原菌分布及血清降钙素原和白细胞介素-6水平对其预后的预测价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年12
页码:
1155-1159
栏目:
临床研究
出版日期:
2021-12-05

文章信息/Info

Title:
Distribution of pathogenic bacteria and the value of serum procalcitonin and interleukin-6 levels in predicting the prognosis of patients with ventilator-associated pneumonia
作者:
贾向红; 刘亚博; 周志敏
（许昌市人民医院检验科，河南　许昌　461000）
Author(s):
JIA Xianghong; LIU Yabo; ZHOU Zhimin
(Department of Clinical Laboratory,Xuchang People′s Hospital,Xuchang 461000,Henan Province,China)
关键词:
呼吸机相关性肺炎; 病原菌分布; 降钙素原; 白细胞介素-6
Keywords:
ventilator associated pneumonia infection; distribution of pathogenic bacteria; procalcitonin; interleukin-6
分类号:
R563.1
DOI:
10.7683/xxyxyxb.2021.12.010
文献标志码:
A
摘要:
目的　观察呼吸机相关性肺炎（VAP）患者病原菌分布情况，并探讨血清降钙素原（PCT）和白细胞介素-6（IL-6）水平对患者预后的预测价值。方法　选择2018年3月至2020年3月许昌市人民医院重症监护病房收治的107例VAP患者为研究对象，分析患者病原菌分布情况；根据预后情况将107例患者分为恶化组（n=42）和好转组（n=65），对2组患者血清PCT、IL-6水平及PCT清除率（PCT-c）进行比较，并建立受试者工作特征（ROC）曲线，分析血清PCT、IL-6及PCT-c对患者预后的预测价值。结果　107例VAP患者共检测出病原菌131株，包括革兰阴性菌78株（59.54%），革兰阳性菌45株（34.35%），真菌8株（6.11%）。革兰阴性菌主要为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌，革兰阳性菌主要为金黄色葡萄球菌、肺炎链球菌，真菌主要为白色念珠菌、白假丝酵母菌。好转组患者确诊第1、3、6、9天血清IL-6水平显著低于恶化组（P＜0.05）。2组患者确诊第1天血清PCT水平比较差异无统计学意义（P＞0.05）；确诊第3、6、9天，好转组患者血清PCT水平显著低于恶化组（P＜0.05），血清PCT-c显著高于恶化组（P＜0.05）。ROC曲线分析显示，确诊VAP第3天，血清PCT、PCT-c、IL-6及3项指标联合预测VAP患者预后的曲线下面积（AUC）分别为0.646、0.792、0.715、0.836；3项指标联合预测VAP患者预后的AUC显著高于血清PCT、IL-6单独预测（P＜0.05），3项指标联合与单独血清PCT-c预测VAP患者预后的AUC比较差异无统计学意义（P＞0.05）；血清PCT-c、PCT、IL-6预测VAP患者预后的AUC两两比较差异均无统计学意义（P＞0.05）。以PCT 5.400 μg·L-1、IL-6 27.740 μg·L-1、PCT-c 22.060%为最佳截断值，血清PCT、PCT-c、IL-6及3项指标联合预测VAP患者预后的敏感度分别为42.9%、85.7%、47.6%、95.2%，特异度分别为100.0%、73.8%、93.8%、61.5%；血清PCT-c、3项指标联合预测VAP患者预后的敏感度显著高于血清PCT和IL-6（P＜0.05），单独血清PCT-c与3项指标联合预测VAP患者预后的敏感度比较差异无统计学意义（P＞0.05），血清PCT与IL-6预测VAP患者预后的敏感度比较差异无统计学意义（P＞0.05）。血清PCT、IL-6预测VAP患者预后的特异度显著高于PCT-c及3项指标联合检测（P＜0.05），血清PCT与IL-6预测VAP患者预后的特异度比较差异无统计学意义（P＞0.05），血清PCT-c与3项指标联合预测VAP患者预后的特异度比较差异无统计学意义（P＞0.05）。结论　VAP患者的病原菌以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、肺炎链球菌为主，血清PCT、PCT-c、IL-6检测有助于评估VAP患者的病情和预后。
Abstract:
Objective　To observe the distribution of pathogenic bacteria in patients with ventilator-associated pneumonia (VAP),and to investigate the value of serum procalcitonin (PCT) and interleukin-6 (IL-6) levels in predicting the prognosis of patients.Methods　A total of 107 patients with VAP treated in the intensive care unit of Xuchang People′s Hospital from March 2018 to March 2020 were selected as the research subjects.The distribution of pathogenic bacteria was analyzed.The 107 patients were divided into aggravation group (n=42) and good improvement group (n=65) according to the prognosis.The levels of serum PCT,IL-6 and PCT clearance (PCT-c) were compared between the two groups.The predictive value of serum PCT,IL-6 and PCT-c on the prognosis of patients was analyzed by the receiver operating characteristic (ROC) curve.Results　A total of 131 pathogenic bacteria were detected in the 107 VAP patients,including 78 strains of Gram-negative bacteria (59.54%),45 strains of Gram-positive bacteria (34.35%) and 8 strains of fungi (6.11%).The Gram-negative bacteria mainly included Klebsiella pneumoniae,Pseudomonas aeruginosa and Escherichia coli.The Gram-positive bacteria mainly included Staphylococcus aureus and Streptococcus pneumoniae.The fungi mainly included Candida albicans and Candida albicans.The level of serum IL-6 in the improvement group was significantly lower than that in the aggravation group on the 1st,3rd,6th and 9th day after diagnosis (P<0.05).There was no significant difference in serum PCT level between the two groups on the 1st day after diagnosis (P>0.05).On the 3rd,6th and 9th day after diagnosis,the serum PCT level in the improvement group was significantly lower than that in the aggravation group (P<0.05),and the serum PCT-c in the improvement group was significantly higher than that in the aggravation group (P<0.05).The ROC curve analysis showed that the area under curve (AUC) of serum PCT,PCT-c,IL-6 and the three indexes combined to predict the prognosis of VAP patients was 0.646,0.792,0.715 and 0.836 on the 3rd day after diagnosis.The AUC of the three indexes combined to predict the prognosis of VAP patients was significantly higher than that of serum PCT and IL-6 (P<0.05).There was no significant difference in AUC of predicting the prognosis of VAP patients between the combination of three indexes and serum PCT-c alone (P>0.05).There was no significant difference in AUC of predicting the prognosis of VAP patients between the serum PCT-c,PCT and IL-6 (P>0.05).Take 5.400 μg·L-1,27.740 μg·L-1,22.060% as the best cut-off value of PCT,IL-6 and PCT-c,the sensitivity of serum PCT,PCT-c,IL-6 and the three indexes combination to predict the prognosis of VAP patients was 42.9%,85.7%,47.6% and 95.2%,respectively;and the specificity was 100.0%,73.8%,93.8% and 61.5%,respectively.The sensitivity of serum PCT-c and the three indexes combination in predicting the prognosis of VAP patients was significantly higher than that of serum PCT and IL-6 (P<0.05).There was no significant difference in the sensitivity of the serum PCT-c alone and the three indexes in predicting the prognosis of VAP patients (P>0.05).There was no significant difference in the sensitivity of serum PCT and IL-6 in predicting the prognosis of VAP patients (P>0.05).The specificity of serum PCT and IL-6 in predicting the prognosis of VAP patients was significantly higher than that of PCT-c and the three indexes combination (P<0.05).There was no significant difference in the specificity of serum PCT and IL-6 in predicting the prognosis of VAP patients (P>0.05).There was no significant difference in the specificity of serum PCT-c and the three indexes combination in predicting the prognosis of VAP patients (P>0.05).Conclusion　The pathogenic bacteria of VAP patients are mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli,Staphylococcus aureus and Streptococcus pneumoniae.Detecting the serum PCT,PCT-c and IL-6 is helpful to evaluate the pathogenetic condition and prognosis of VAP patients.

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更新日期/Last Update: 2021-12-05