摘要
目的研究革兰阴性细菌和革兰阳性细菌感染的脓毒症患者炎症因子含量与其病情和预后关系。方法收集南京医科大学附属明基医院2016年5月-2021年5月收治的脓毒症患者75例,根据患者细菌感染类型分组,致病菌为革兰阳性菌为G^(+)组(n=30),致病菌为革兰阴性菌为G^(-)组(n=45),根据病情严重程度分为脓毒症组(n=57)和休克组(n=18),根据预后分为存活组(n=53)和死亡组(n=22)。收集上述各分组患者临床资料及炎症因子[降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)]含量,分析其在各组间含量及感染情况与病情和预后的关系。结果G^(-)组PCT、CRP、IL-6含量均高于G^(+)组(t=6.309、11.976、4.776,P均<0.001),休克组PCT、CRP、IL-6含量均高于脓毒症组(t=9.970、29.771、3.831,P均<0.001),死亡组PCT、CRP、IL-6含量均高于存活组(t=7.552、20.579、2.714,P均<0.001),差异均有统计学意义。G^(-)组各炎症指标诊断脓毒症休克患者ROC曲线结果显示:PCT、CRP、IL-6、联合诊断AUC值依次为0.780(95%CI:0.646~0.914)、0.803(95%CI:0.675~0.931)、0.754(95%CI:0.520~0.988)、0.897(95%CI:0.795~0.999),组间比较差异无统计学意义(Z=1.342、1.228、1.486,P=0.179、0.219、0.137)。G^(+)组各炎症指标诊断脓毒症休克患者ROC曲线结果显示:PCT、CRP、IL-6、联合诊断AUC值依次为0.744(95%CI:0.553~0.855)、0.750(95%CI:0.559~0.889)、0.699(95%CI:0.505~0.852)、0.940(95%CI:0.789~0.994),PCT、CRP、IL-6分别与联合诊断比较差异有统计学意义(Z=2.015、2.098、2.260,P=0.044、0.036、0.024)。75例脓毒症患者28 d总生存率为70.67%(53/75),其中G^(+)组、G^(-)组生存率经Log-rank检验差异无统计学意义(χ^(2)=0.243,P=0.622)。结论PCT、CRP、IL-6单一和联合诊断对革兰阴性菌脓毒症休克患者有较高的诊断预测价值,革兰阳性菌脓毒症休克患者则可将三者联合以提高诊断预测价值;但脓毒症患者预后在不同细菌感染类型间差异无统计学意义。
Objective To study the relationship between the levels of inflammatory factors and their disease severity and prognosis in sepsis patients infected with Gram-negative bacteria and Gram-positive bacteria.Methods A retrospective analysis of 75 patients with sepsis admitted to the hospital from May 2016 to May 2021.According to the type of bacterial infection,patients were divided into G^(+)group(the pathogenic bacteria were Gram-positive bacteria,n=30)and G^(-)group(the pathogenic bacteria were Gram-negative bacteria,n=45);according to the severity of the disease,patients were divided into sepsis group(n=57)and shock group(septic shock,n=18),and according to prognosis,they were divided into survival group(n=53)and death group(n=22).The clinical data and the contents of inflammatory factors[procalcitonin(PCT),C-reactive protein(CRP),and interleukin-6(IL-6)]were collected.The relationships between inflammatory factors,disease status and prognosis were analyzed.Results The contents of PCT,CRP and IL-6 in the G^(-)group were higher than those in the G^(+)group,the differences were statistically significant(t=6.309,11.976,4.776,all P<0.001).The contents of PCT,CRP and IL-6 in the shock group were higher than those in the sepsis group(t=9.970,29.771,3.831,all P<0.001),and the contents of PCT,CRP and IL-6 in the death group were higher than those in the survival group(t=7.552,20.579,2.714,all P<0.001);the differences were statistically significant.The ROC curve results of each inflammatory index in the G^(-)bacteria group in the diagnosis of septic shock patients showed that the AUC values of PCT,CRP,IL-6,and combined diagnosis were 0.780(95%CI:0.646-0.914),0.803(95%CI:0.675-0.931),0.754(95%CI:0.520-0.988)and 0.897(95%CI:0.795-0.999),respectively;there were no significant differences between the groups(Z=1.342,1.228,1.486,P=0.179,0.219,0.137).The ROC curve results of each inflammatory index in the G^(+)bacteria group in the diagnosis of septic shock patients showed that the AUC values of PCT,CRP,IL-6 and combined diagnosis were 0.744(95%CI:0.553-0.855),0.750(95%CI:0.559-0.889),0.699(95%CI:0.505-0.852),and 0.940(95%CI:0.789-0.994),respectively;the differences were statistically significant(Z=2.015,2.098,2.260,P=0.044,0.036,0.024).The 28-day overall survival rate of 75 patients with sepsis was 70.67%(53/75),and there was no significant difference in the survival rate between G^(+)group and G^(-)group(χ^(2)=0.243,P=0.622).Conclusions The single and combined diagnosis of PCT,CRP,and IL-6 had a high diagnostic and predictive value in patients with G^(-)bacterial septic shock,and the combination of the three could improve the diagnostic and predictive value in patients with G^(+)bacterial septic shock.However,there was no statistically significant difference in the prognosis of sepsis patients among different bacterial infection types.
作者
张伟
邢娟
谢辉
ZHANG Wei;XING Juan;XIE Hui(Department of Critical Care Medicine,BenQ Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210019,China)
出处
《热带医学杂志》
CAS
2023年第5期678-682,共5页
Journal of Tropical Medicine
基金
国家临床重点专科建设项目(2011873)
关键词
脓毒症
细菌感染
革兰阴性菌
革兰阳性菌
炎症因子
Sepsis
Bacterial infection
Gram-negative bacteria
Gram-positive bacteria
Inflammatory factors
