革兰阴性菌和革兰阳性菌血流感染危重患者中致炎症反应的比较  

Comparison of inflammatory reaction between gram-negative and gram-positive bloodstream infections in critical patients

作　　者：吴志恒[1] 郭玉霞[1] 卜婧[1] 郭翠翠[1] 谢佳[1] 穆玉[2] 

机构地区：[1]武警医学院附属医院药剂科,天津300161 [2]天津医科大学总医院

出　　处：《中国感染与化疗杂志》2012年第1期27-31,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的比较医院感染革兰阴性菌血流感染和革兰阳性菌血流感染的炎性介质指标,观察革兰阴性菌血流感染和革兰阳性菌血流感染导致炎症反应的程度。方法前瞻性分析入住ICU48 h后血培养阳性患者的性别,年龄,APACHEⅡ和SOFA评分,慢性疾病史,病情严重程度,静脉营养,接受手术或外科操作,机械通气支持和血液净化治疗,混合细菌血流感染,入住ICU时间及医院内病死率情况。比较革兰阴性菌血流感染和革兰阳性菌血流感染患者的体温,心率,白细胞(WBC)数量,中性粒细胞(NEU)数量,淋巴细胞(LYM)数量,C-反应蛋白(CRP),降钙素原(PCT),肿瘤坏死因子-α(TNF-α),白介素-1β(IL-1β)和白介素-6(IL-6)水平。结果与革兰阳性菌血流感染相比,革兰阴性菌血流感染组有更多的患者表现为严重脓毒症或脓毒性休克[(88.9%∶73.0%,P=0.003)],高血清TNF-α[(0.97±0.54)∶(0.75±0.32),P=0.029]和IL-1β[(7.03±0.12)∶(2.21±0.09),P=0.006]和IL-6[(10.59±2.48)∶(2.55±0.75),P=0.005]水平。结论革兰阴性菌血流感染患者较革兰阳性菌血流感染患者的临床病情更加严重,表现为更加严重的炎症反应,在血流感染的临床治疗中应考虑病原菌的致病机制和宿主的反应程度。Objective To investigate the extent of inflammatory reaction induced by nosocomial gram-negative or gram-positive bloodstream infections through comparing some clinical indicators and levels of inflammatory mediators. Methods Prospective analysis was conducted in patients with positive blood culture obtained 48 h after admission to ICU, in terms of patient gender, age, APACHE II and Sequential organ failure assessment （SOFA） scores, underlying diseases, severity of infection, total parenteral nutrition, receiving operation or surgical procedure, mechanical ventilation, blood purification therapy, mixed bacterial bloodstream infection, length of ICU stay and in hospital mortality. The parameters such as temperature, heart rate, WBC count, neutrophils, lymphocytes, levels of C-reactive protein, calcitonin, tumor necrosis factor-α （TNF-a）, interleukin-1β （IL-1β） and interleukin-6 （IL-6） were also compared between the patients with gram-positive bloodstream infection and those with gram-negative bloodstream infection. Results The incidence of severe sepsis and septic shock was significantly higher in the patients with gram-negative bloodstream infection than in those with gram-positive bloodstream infection （88.9% vs. 73%, P = 0. 003）. Blood levels of TNF-a （0. 97 ± 0.54 vs. 0. 75 ± 0. 32, P = 0.029）, IL-1β （7.03 ± 0.12 vs. 2.21 ± 0.09, P=0.006）and IL-6 （10.59 ± 2.48 vs. 2.55 ± 0.75, P= 0. 005） increased more in the patients with gram-negative bloodstream infection than in the patients in gram-positive bloodstream infection. Conclusions The patients with gram-negative bloodstream infection show more severe clinical condition and inflammatory reaction than the patients with gram-positive bloodstream infection. The pathogenic mechanism and extent of the host inflammatory response should be considered when treating bloodstream infections in clinical practice.

关 键 词：血流感染 炎性反应 炎症介质 

分 类 号：R459.7[医药卫生—急诊医学]