卒中相关性肺炎病原菌分析及血清降钙素原的临床诊疗价值  

Pathogen distribution for patients with stroke-associated pneumonia and clinical diagnosis and treatment value of serum procalcitonin

作　　者：胡旭明[1] 高美慧 鲍琪[2] 张亚平 蒋莉[1] 张咏梅 HU Xu-ming;GAO Mei-hui;BAO Qi;ZHANG Ya-ping;JIANG Li;ZHANG Yong-mei(Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Xiasha Campus , Hangzhou, Zhejiang 310018, China)

机构地区：[1]浙江大学医学院附属邵逸夫医院下沙院区麻醉科,浙江杭州310018 [2]浙江大学医学院附属邵逸夫医院麻醉科,浙江杭州310016 [3]复旦大学附属华山医院感染科,上海200040

出　　处：《中华医院感染学杂志》2018年第3期344-347,351,共5页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(1200282632)

摘　　要：目的观察分析卒中相关性肺炎患者的病原菌分布情况,探讨降钙素原(PCT)在卒中相关性肺炎患者体内水平,为临床诊断提供参考。方法选择2014年6月-2016年6月于医院治疗的87例脑卒中合并肺部感染患者的临床资料。以患者入院当天的PCT中位数4.77ng/ml为界将患者分为高水平组(PCT≥4.77ng/ml)44例及低水平组(PCT<4.77ng/ml)43例。对病原菌进行分型;采用Pearson相关性检验分析患者PCT水平与临床肺部感染评分(CPIS)的相关性;采用Log-rank检验比较两组患者的累积死亡率。结果 87例感染患者共分离致病菌117株,其中革兰阴性菌78株占66.67%,革兰阳性菌32株占27.35%,真菌7株占5.98%;卒中相关性肺炎患者的PCT水平与CPIS呈正相关(P<0.05);PCT高水平组的C-反应蛋白(CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)分别为(28.42±6.31)mg/ml、(19.81±5.12)ng/ml及(21.63±4.26)ng/ml均高于PCT低水平组(23.51±5.74)mg/ml、(16.73±4.92)ng/ml及(18.43±3.84)ng/ml(P<0.01);治疗4周后,高水平组死亡率为18.18%高于低水平组患者4.65%(P<0.05)。结论 PCT水平与疾病的严重程度与体内的炎症反应程度有关,检测PCT水平可作为卒中相关性肺炎的诊断及评估预后的良好指标。OBJECTIVE To explore the pathogen distribution for patients with stroke-associated pneumonia and in- vestigate the level of procalcitonin （PCT） in patients with stroke-associated pneumonia, so as to provide references for clinical diagnosis.METHODS A total of 87 cases of patients with stroke-associated pneumonia received treat- ment in our hospital from Jun. 2014 to Jun. 2016 were enrolled in this study. Patients were divided into two groups according to the levels of PCT, including group A （PCT≥4.77 ng/ml,n=44） and group B （PCT〈4.77 ng/ml,n = 43）. Pathogenic bacteria typing was carried out. The Pearson correlation test was used to analyze the correlation between PCT level and CPIS of clinical pulmonary infection. The Log-rank test was used to compare the cumula- tive mortality of the two groups. RESULTS Totally 117 strains of pathogens were isolated from 87 infected pa- tients, including 78 （66.67 %） strains of gram-negative bacteria , 32 （27.35 %） strains of gram-positive bacteria, and 7 （5.98%） strains of fungi. Correlation analysis showed that, the levels of PCT had significant positive correla- tion with CPIS （P〈0.05）. The levels of C-reactive（CRP）, interleukin-6 （IL-6） and tumor necrosis factor-α（TNF- α） of group A were （28.42±6.31）mg/ml, （19.81±5.12）ng/ml and （21.63±4.26）ng/ml, which were higher than （23.51±5.74）mg/ml, （16.73±4.92）ng/ml and （18.43±3.84）ng/ml of group B （P〈0.05）. After 4 weeks of treatment, the cumulative mortality of group A was 18.18%, which was higher than 4.65% of group B（P〈0. 05）.CONCLUSION The level of PCT is related to the severity of the disease and the degree of inflammation in the body, and detection of PCT level can be used as a good indicator for the diagnosis and evaluation of prognosis of stroke-associated pneumonia.

关 键 词：卒中相关性肺炎 降钙素原 病原菌分布 炎症因子 

分 类 号：R563.1[医药卫生—呼吸系统]