妇科肿瘤PICC置管后CRBSI感染患者sTREM-1和PCT及T细胞亚群分析  

Analysis of sTREM-1, PCT and T cell subsets in gynecological tumor patients with catheter-related bloodstream infection after PICC catheterization

作　　者：刘静[1] 刘洋[2] 陶中娥[3] 冯爽[4] 田丽[5] LIU Jing;LIU Yang;TAO Zhong-e;FENG Shuang;TIAN Li(Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院门诊,天津300170 [2]天津市第一中心医院放射科,天津300192 [3]天津市第一中心医院妇科,天津300192 [4]天津市海河医院检验科,天津300350 [5]天津市第三中心医院护理部,天津300170

出　　处：《中华医院感染学杂志》2019年第23期3618-3622,3627,共6页Chinese Journal of Nosocomiology

基　　金：天津市卫计委科技基金资助项目(2013kz025)

摘　　要：目的探讨妇科肿瘤经外周静脉置入中心静脉导管(Peripherally Inserted Central Venous Catheters,PICC)置管后,导管相关性血流感染(Catheter Related Blood Stream Infection,CRBSI)患者可溶性髓系细胞触发受体-1(Soluble Triggering Receptor Expressed On Myeloid cell-1,sTREM-1)、降钙素原(Procalcitonin,PCT)及T细胞亚群等免疫指标的表达及意义。方法随机选取2015年4月-2018年4月于天津市第三中心医院和天津市第一中心医院妇科收治的经CT或MRI确诊的行PICC术的妇科肿瘤患者253例,根据是否发生感染分为感染组和对照组,其中感染组39例,对照组214例。对感染组PICC术后CRBSI病原菌、感染相关因素和感染率进行临床统计和分析。并对感染组和对照组sTREM-1、PCT及T细胞亚群水平进行检测和对比分析。结果39例CRBSI患者共检测43株病原菌,革兰阳性菌21株占48.84%,以表皮葡萄球菌为主;革兰阴性菌16株占37.21%,以阴沟肠杆菌为主;真菌6株占13.95%,以假丝酵母为主。单因素分析显示年龄、导管留置时间、肠外输注营养与PICC置管后CRBSI感染率相关(P<0.05)。术后感染组sTREM-1及PCT增加高于术前;术前对照组CD4^+/CD8^+高于感染组(P<0.05);术后对照组CD3^+、CD4^+水平升高,CD8^+水平下降,感染组术后CD3^+、CD4^+水平及CD4^+/CD8^+降低,CD8^+水平上升,均具有统计学意义(P<0.05);且对照组与感染组CD3^+、CD4^+、CD8^+及CD4^+/CD8^+术前术后差值比较,均具有统计学意义(P<0.05)。结论妇科肿瘤患者PICC置管后CRBSI感染病原学分布以革兰阳性球菌为主,年龄、导管留置时间、肠外输注营养及CD4^+/CD8^+水平对感染的发生有影响,术后CRBSI感染者sTREM-1、PCT、CD8^+明显升高,CD3^+、CD4^+及CD4^+/CD8^+水平下降,免疫功能降低,具有临床诊断意义。OBJECTIVE To investigate the expression and significance of immune indexes such as soluble triggering receptor expressed on myeloid cell-1(sTREM-1),procalcitonin(PCT)and T cell subsets in gynecological tumor patients with catheter-related bloodstream infection after catheterization of peripherally inserted central venous catheters.METHODS Totally 253 patients with gynecological tumors diagnosed by CT or MRI and treated with PICC in the gynecology department of Tianjin Third Central Hospital and Tianjin First Central Hospital from Apr.2015 to Apr.2018 were randomly selected.They were divided into the infected group(39 patients)and the control group(214 patients).The distribution,composition ratio,relevant factors and infection rate of catheter-related bloodstream infection(CRBSI)after PICC in the infected group were analyzed.The levels of sTREM-1,PCT and T cell subgroups in the two groups were tested and compared.RESULTS A total of 43 strains of patehogens were detected in the 39 patients with bloodstream infection,of which 21 strains of Gram-positive bacteria accounted for 48.84%,dominated by Staphylococcus epidermidis,16 strains of Gram-negative bacteria accounted for 37.21%,dominated by Enterobacter cloacae,and 6 strains of fungi accounted for 13.95%,dominated by Candida.Univariate analysis showed that the age,length of catheter retention,and the parenteral infusion nutrition were correlated with the infection rate of CRBSI after PICC(P<0.05).The sTREM-1 and PCT after surgery in the infected group were significantly higher than those before surgery.Before surgery,the level of CD4^+/CD8^+ in the control group was significantly higher than that in the infected group(P<0.05).After surgery,the levels of CD3^+,CD4^+ in the control group increased,whereas the level of CD8^+decreased.The levels of CD3^+,CD4^+ and CD4^+/CD8^+ in the infected group all decreased after surgery,whereas the level of CD8^+increased,all differences were significant(P<0.05).The differences between the preoperative and postoperative levels of

关 键 词：妇科肿瘤 PICC 导管相关血流感染 病原菌 STREM-1 T细胞亚群 影响因素 

分 类 号：R473.73[医药卫生—护理学]