血液炎性指标与脓毒血症细菌感染患者病情的相关性研究  

Correlation between blood inflammatory markers and illness condition of patients with sepsis bacterial infection

作　　者：徐少博[1] 刘雪兰[2] 应泽亮[2] 蒋坚[2] 朱立军[2] 夏菁[2] 孙晶[3] 

机构地区：[1]宁波市医疗中心李惠利医院急诊病房,浙江宁波315040 [2]宁波市医疗中心李惠利医院急诊科,浙江宁波315040 [3]温州医学院附属第二医院神经内科,浙江温州325000

出　　处：《中华医院感染学杂志》2017年第2期280-283,共4页Chinese Journal of Nosocomiology

基　　金：浙江省科技厅科技攻关项目(2013C37005)

摘　　要：目的分析脓毒血症细菌感染患者血液炎性指标与病情的关系。方法收集2013年7月-2016年1月医院收治的脓毒血症患者100例,参照病情程度分作脓毒血症组36例、重度脓毒血症组34例、脓毒性休克组30例,分析脓毒血症患者细菌感染情况,比较3组脓毒血症患者血液炎性指标水平(LPS、CRP、PCT、IL-6、WBC)及急性生理与慢性健康状况评分Ⅱ(APACHE-Ⅱ),并分析血液炎性指标水平与APACHE-Ⅱ评分的相关性。结果脓毒血症患者细菌感染主要为大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌,其次为鲍氏不动杆菌及阴沟杆菌;脓毒血症组LPS(28.75±5.69)ng/L、CRP(68.54±12.73)mg/L、PCT(0.84±0.21)μg/L、IL-6(29.85±6.47)ng/L、WBC(9.81±2.54)×109/L分别低于重度脓毒血症组LPS(37.18±7.24)ng/L、CRP(129.20±17.62)mg/L、PCT(8.41±0.81)μg/L、IL-6(53.22±11.41)ng/L、WBC(11.35±3.06)×109/L,且低于脓毒性休克组LPS(44.79±8.25)ng/L、CRP(153.24±21.38)mg/L、PCT(11.37±1.05)μg/L、IL-6(85.60±16.28)ng/L、WBC(14.79±3.54)×109/L,比较差异有统计学意义(P<0.05);脓毒血症组APACHE-Ⅱ评分(12.16±3.51)分低于重度脓毒血症组(21.12±4.93)分且低于脓毒性休克组(26.29±5.63)分,比较差异有统计学意义(P<0.05);脓毒血症患者血液LPS、CRP、PCT、IL-6、WBC水平和APACHE-Ⅱ评分为正相关,差异有统计学意义(P<0.05)。结论脓毒血症细菌感染患者血液炎性指标水平与病情程度表现为正相关,可以作为临床上评估患者病情、预后的可靠指标。OBJECTIVE To observe the correlation between blood inflammatory markers and illness condition of patients with sepsis bacterial infection. METHODS A total of 100 patients with sepsis who were treated in hospitals from Jul 2013 to Jan 2016 were enrolled in the study and were divided into the sepsis group with 36 cases, the severe sepsis group with 34 cases, and the septic shock group with 30 cases according to the severity of illness. The incidence of bacterial infection in the sepsis patients was analyzed, the levels of blood inflammatory markers （LPS, CRP, PCT, IL-6, WBC） and acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ score were compared among the three groups of sepsis patients; the correlation between the levels of blood inflammatory markers and the APACHE-Ⅱ score was observed. RESULTS Escherichia coli, Klebsiella pneumoniae, coagulase-negative Staphylococcus, and Staphylococcus aureus were the predominant species of pathogens causing the bacterial infection in the sepsis patients, followed by Acinetobacter baumannii and Enterobacter cloacae. The levels of LPS, CRP, PCT, IL-6, and WBC of the sepsis group were respectively （28.75±5.69）ng/L, （68.54±12.73）mg/L, （0.84±0.21）μg/L, （29.85±6.47）ng/L, and WBC（9.81±2.54） × 10^9/L, lower than （37. 18±7.24）ng/L,（129.20±17.62）mg/L, （8.41±0.81）μg/L, （53.22± 11.41）ng/L, and （11.35±3.06） × 10^9/L of the severe sepsis group and （44.79±8.25）ng/L, （153.24±21.38）mg/L, （11.37±1.05）μg/L, （85.60±16.28）ng/L, and （14.79 ±3.54） × 10^9/L of the septic shock group, and there was significant difference （P〈0.05）. The APACHE- Ⅱ score of the sepsis group was （12. 16 ±3.51）points, lower than （21. 12 ± 4. 93） points of the severe sepsis group and （26.29 ± 5.63）points of the septic shock group, and there was significant difference （P〈0.05）. The levels of blood LPS, CRP, PCT, IL-6, and WBC of the sepsis patients were positively correlated with the APACHE-Ⅱ sc

关 键 词：脓毒血症 细菌感染 炎性指标 病情 相关性 

分 类 号：R631.1[医药卫生—外科学]