区分呼吸系统泛耐药鲍曼不动杆菌感染与定植的评分系统的建立和评价  

Establishment and evaluation of a scoring system to distinguish infection from colonization of extensively drug-resistant Acinetobacter baumannii in respiratory system

作　　者：刘秋萍[1] 顾晓花[2] 汤瑾[3] 王坚镪[3] 任增花 张瑶 徐凌[2] LIU Qiu-ping;GU Xiao-hua;TANG Jin;WANG Jian-qiang;REN Zeng-hua;ZHANG Yao;XU Ling(Department of Respiratory Medicine,Shanghai Jiao Tong University Affiliated Sixth People’s HospitalSouth Campus,Shanghai Fengxian District Central Hospital,Shanghai201400,China;Department of Respiratory Medicine;Department ofClinical Laboratory,Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,Shanghai200030,China)

机构地区：[1]上海交通大学附属第六人民医院南院(上海市奉贤区中心医院),呼吸内科,上海201400 [2]上海交通大学附属第六人民医院,呼吸内科,上海200030 [3]上海交通大学附属第六人民医院,检验科,上海200030

出　　处：《临床肺科杂志》2021年第3期393-398,410,共7页Journal of Clinical Pulmonary Medicine

摘　　要：目的建立区分呼吸系统泛耐药鲍曼不动杆菌(XDRAB)感染与定植的评分系统。方法选择2011年1月至2016年12月在上海市第六人民医院呼吸道标本培养出XDRAB的患者272例(定植142例,感染130例)。利用单因素分析进行筛选,然后使用多因素logistic回归分析发现感染的独立预测因素并建立评分系统,采用ROC曲线评价该评分系统,并进行准确性验证。结果通过建模样本建立评分系统:Z=42×培养出XDRAB时最高体温(≥38℃为1分,<38℃为0分)+18×新出现症状或原有症状加重(是为1分,否为0分)+32×白细胞数(≥10.6×10^(9)/L为1分,反之为0分)+43×胸部影像学变化(新出现炎性浸润影或炎性浸润影加重为1分,否则为0分),该评分系统ROC曲线下面积为0.973(95%CI:0.954~0.992)。当Z<75分时考虑为定植,≥75分时考虑为感染。在测试样本中该评分系统对XDRAB感染和定植的预测与实际相符率为85.56%,阳性预测值为0.930,阴性预测值为0.787。结论该评分系统能较准确地区分呼吸系统XDRAB的感染和定植,从而为治疗提供依据。Objective To establish a simple scoring system to distinguish infection from colonization of extensively drug-resistant Acinetobacter baumannii(XDRAB)in respiratory system.Methods 272 patients with XDRAB cultured from sputum/bronchial lavage fluid at the Shanghai Sixth People′s Hospital from January 2011 to December 2016 were divided into two groups(142 colonization cases and 130 infection cases).Variables associated with infection were identified by multivariable logistic regression,and then a scoring system was established.The discriminatory power was evaluated by the area under the receiver operating characteristic(ROC)curve,and the scoring system was verified in the test samples.Results It used the modelling samples to establish the scoring system:Z=42×the highest body temperature(the value was 1 when≥38℃and 0 when<38℃)+18×new symptoms or aggravation of previous symptoms(Yes=1,No=0)+32×white blood cell count(the value was 1 when≥10.6×109/L and 0 when<10.6×10^(9)/L)+43×new or progressive inflammatory infiltrating shadows(Yes=1,No=0).The area under the ROC curve of this scoring system was 0.973(95%CI:0.954~0.992).The cut-off value of Z score was 75(sensitivity 0.885,specificity 0.968).Z score<75 indicated colonization,and Z score≥75 indicated infection.Then,this scoring system was evaluated in the test samples.The coincidence rate between the predicted and observed values was 85.56%.The positive predictive value was 0.930,and the negative predictive value was 0.787.Conclusion This scoring system can accurately distinguish XDRAB infection from colonization in respiratory system,which can provide evidences for treatment.

关 键 词：泛耐药鲍曼不动杆菌 感染 定植 评分系统 

分 类 号：R446.5[医药卫生—诊断学]