ERCP术后血流感染的危险因素及新型感染性标志物的诊断价值  

Risk factors for postoperative bloodstream infection in ERCP patients and diagnostic value of novel infectious markers

作　　者：孙亭立[1] 刘合春[1] 何春华[2] SUN Ting-li;LIU He-chun;HE Chun-hua(Jiujiang No.1 People′s Hospital,Jiujiang,Jiangxi 332000,China;不详)

机构地区：[1]九江市第一人民医院肝胆外科,江西九江332000 [2]嘉兴学院附属第二医院胃肠外科,浙江嘉兴314000

出　　处：《中华医院感染学杂志》2021年第17期2697-2701,共5页Chinese Journal of Nosocomiology

基　　金：江西省卫生健康委科技计划基金资助项目(202120061)。

摘　　要：目的分析经内镜逆行胰胆管造影(ERCP)术后血流感染的危险因素,并探讨新型感染性标志物血清淀粉样蛋白A(SAA)、髓细胞上表达的触发受体1(TREM-1)和瓜氨酸化组蛋白H3(Cit H3)对ERCP术后血流感染的诊断价值。方法选取2015年1月-2020年7月九江市第一人民医院和嘉兴学院附属第二医院收治的行ERCP术患者269例,比较ERCP术后血流感染患者和非血流感染患者临床资料,采用多因素Logistic回归分析影响ERCP术后血流感染的危险因素,绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评估血清SAA、TREM-1以及Cit H3对ERCP术后血流感染的诊断价值。结果269例行ERCP术患者中80例为血流感染患者,感染率为29.74%,检出的94株病原菌中革兰阴性菌占77.66%(73/94),革兰阳性菌占22.34%(21/94);单因素和多因素Logistic回归结果,疾病恶性性质、ERCP术操作时间(>60min)、行括约肌切开术、置入支架、SAA(≥90.75mg/L)、TREM-1(≥82.75ng/L)以及Cit H3(≥151.18ng/ml)是ERCP术后血流感染的独立危险因素(P<0.05);ROC曲线结果,SAA、TREM-1、Cit H3三者联合检测对ERCP术后血流感染的AUC为0.925、灵敏度为88.75%、特异度为85.71%,均高于SAA、TREM-1、Cit H3单独检测。结论ERCP术后血流感染率较高,疾病性质、ERCP操作时间、行括约肌切开术、置入支架、SAA、TREM-1以及Cit H3是影响ERCP术后血流感染的独立危险因素,联合检测SAA、TREM-1以及Cit H3水平有助于提高对ERCP术后血流感染的诊断价值。OBJECTIVE To analyze the risk factors for postoperative bloodstream infection in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)and explore the value of novel infectious markers serum amyloid A(SAA),triggering receptors expressed on myeloid cells-1(TREM-1)and circulating citrullinated histone H3(Cit H3)in diagnosis of postoperative bloodstream infection.METHODS A total of 269patients who underwent ERCP in the Jiujiang No.1People′s Hospital and the Second Affiliated Hospital of Jiaxing University from Jan 2015to Jul 2020were enrolled in the study.The clinical data were compared between the patients with bloodstream infection and the patients without bloodstream infection after ERCP.Multivariate logistic regression analysis was performed for the postoperative bloodstream infection in the ERCP patients,receiver-operating-characteristic(ROC)curve was drawn to analyze the value of serum SAA,TREM-1and Cit H3in diagnosis of postoperative bloodstream infection by area under curve(AUC).RESULTS Of the 269patients who underwent ERCP,80had bloodstream infection,with the infection rate 29.74%.Totally 94strains of pathogens were isolated,77.66%(73/94)of which were gram-negative bacteria,22.34%(21/94)were gram-positive bacteria.The results of univariate analysis and multivariate logistic regression analysis showed that malignancy of disease,duration of ERCP more than 60min,sphincterotomy,placement of stent,SAA no less than 90.75mg/L,TREM-1no less than 82.75ng/L and Cit H3no less than 151.18ng/ml were independent risk factors for the postoperative bloodstream infection in the ERCP patients(P<0.05).ROC curve analysis indicated that the AUC of the joint detection of SAA,TREM-1and Cit H3was 0.925in diagnosis of postoperative bloodstream infection,the sensitivity 88.75%,the specificity 85.71%,higher than those of the single detection of SAA,TREM-1and Cit H3.CONCLUSION The incidence of bloodstream infection is high after ERCP.The nature of disease,duration of ERCP,sphincterotomy,placement of stent,SAA,TREM-

关 键 词：经内镜逆行胰胆管造影 血流感染 淀粉样蛋白A 髓细胞上表达的触发受体1 瓜氨酸化组蛋白H3 

分 类 号：R6193[医药卫生—外科学]