摘要
目的:探讨老年慢性阻塞性肺疾病急性加重期(AECOPD)患者痰培养结果与血清C反应蛋白(CRP)、淀粉样蛋白A(SAA)、降钙素原(PCT)水平的相关性。方法:回顾性分析绍兴文理学院附属医院2019年1月至2021年1月收治的老年AECOPD患者131例的临床资料,根据痰培养结果将患者分为痰培养阳性组(n=52)和痰培养阴性组(n=79)。采集患者痰液,进行病原菌分离鉴定。记录两组年龄、性别、吸烟史、合并基础疾病(高血压、糖尿病和冠心病)、白蛋白水平、机械通气、吸痰方式、抗生素使用时间及住院时间等一般资料,采用二分类logistic回归分析分析影响老年AECOPD患者痰培养阳性的因素;采用受试者工作特征(ROC)曲线分析血清CRP、SAA和PCT水平预测老年AECOPD患者痰培养阳性的诊断效能。结果:52例老年AECOPD痰培养阳性患者共分离出67株病原菌,分离菌株以克雷伯杆菌(31.34%)为代表的革兰阴性菌(67.16%)为主,其次为革兰阳性菌(25.37%),真菌最少(7.47%)。logistic回归分析显示,有机械通气(OR=2.75,P=0.020)、使用广谱抗生素(OR=2.95,P=0.012)、血清CRP≥20.96 mg/L(OR=2.44,P=0.007)、SAA≥18.03 mg/L(OR=2.67,P=0.016)和PCT≥2.08μg/L(OR=2.51,P=0.013)均为影响老年AECOPD患者痰培养阳性的独立危险因素;ROC曲线分析显示,血清CRP、SAA和PCT联合检测的曲线下面积(AUC)为0.896,对老年AECOPD患者痰培养阳性有预测效能(P<0.05)。结论:老年AECOPD患者痰培养病原菌以革兰阴性菌为主,其血清CRP、SAA和PCT明显升高,是痰培养阳性的独立危险因素,三者联合检测具有较高的诊断效能,可用于老年AECOPD患者痰培养结果的评估。
Objective:To investigate the correlation between sputum culture results and serum levels of C-reactive protein,amyloid A,and procalcitonin in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods:The clinical data of 131 older adult patients with AECOPD who received treatment in the Affiliated Hospital of Shaoxing University between January 2019 and January 2021 were retrospectively analyzed.According to sputum culture results,these patients were divided into a sputum culture positive group(n=52)and a sputum culture negative group(n=79).The sputum of patients was collected aseptically for isolation and identification of pathogens.The general data[age,gender,history of smoking,underlying diseases(hypertension,diabetes mellitus,coronary heart disease),albumin level,mechanical ventilation,method of sputum suction,duration of antibiotics medication,length of hospital stay]were recorded for each group.The risk factors for positive sputum culture were analyzed using binary logistic regression techniques.The efficiency of serum levels of C-reactive protein,amyloid A,and procalcitonin for predicting positive sputum culture was analyzed using the receiver operating characteristic curve.Results:There were 67 strains of pathogens isolated from 52 older adult patients with positive sputum culture of AECOPD.The main pathogens were Gram-negative bacteria(67.16%)[Klebsiella pneumonia(31.34%)],followed by Gram-positive bacteria(25.37%)and fungi(7.47%).Logistic regression analysis showed that mechanical ventilation(OR=2.75,P=0.020),usage of broad-spectrum antibiotics(OR=2.95,P=0.012),serum C-reactive protein level≥20.96 mg/L(OR=2.44,P=0.007),serum amyloid A level≥18.03 mg/L(OR=2.67,P=0.016)and serum procalcitonin level≥2.08μg/L(OR=2.51,P=0.013)were independent risk factors of positive sputum culture in older adult patients with AECOPD.The receiver operating characteristic curve analysis showed that the area under the receiver operating characteristic curve depicting serum levels of C-reactive protein,amyloid A,and procalcitonin in combination for predicting AECOPD was 0.896,which is of predictive efficiency for positive sputum culture(P<0.05).Conclusion:The sputum culture pathogens in older adult patients with AECOPD are mainly Gram-negative bacteria.Increased serum levels of C-reactive protein,amyloid A,and procalcitonin are independent risk factors for Gram-positive bacteria.Combined detection of serum levels of C-reactive protein,amyloid A,and procalcitonin is highly efficient in the diagnosis of AECOPD and can be used to evaluate the sputum culture results in older adult patients with AECOPD.
作者
何菁
俞叶夫
陈能松
He Jing;Yu Yefu;Chen Nengsong(Department of Laboratory Medicine,Affiliated Hospital of Shaoxing University,Shaoxing 312000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2023年第2期161-166,共6页
Chinese Journal of Primary Medicine and Pharmacy
关键词
肺疾病
慢性阻塞性
C反应蛋白质
血清淀粉样蛋白A
降钙素
细菌感染
因素分析
统计学
Pulmonary disease,chronic obstructive
C-reactive proteinSerum amyloid A protein
Calcitonin
Bacterial infections
Factor analysis,statistical
