肺炎链球菌血流感染患儿的生存分析及mNAP、Presepsin、TREM-1水平的早期预测价值  

Survival analysis on children with Streptococcus pneumoniae bloodstream infection and the early predictive value of mNAP,Presepsin and TREM-1

作　　者：刘新光[1] 崔玉娇[2] 王毅 王海娇 王盛华[1] 吴昊[1] LIU Xin-guang;CUI Yu-jiao;WANG Yi;WANG Hai-jiao;WANG Sheng-hua;WU Hao(Hebei Children’s Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院,石家庄050031 [2]石家庄市妇产医院

出　　处：《医学动物防制》2021年第9期830-833,837,共5页Journal of Medical Pest Control

基　　金：河北省医学科学研究重点课题计划(20180645)。

摘　　要：目的分析肺炎链球菌血流感染患儿的生存情况及mNAP、Presepsin、TREM-1的早期预测价值。方法对2018年1月—2019年12月某院收治的92例肺炎链球菌血流感染患儿进行病原菌血培养,并测定抗菌药物耐药性、敏感性。根据治疗30 d生存情况将入组患儿分为死亡组(n=16)、非死亡组(n=76),采用单因素、多因素分析患儿近期死亡的独立危险因素。采用受试者工作特征曲线(receiver operating characteristic curve, ROC)分析患儿入院早期血清mNAP、Presepsin、TREM-1水平对患儿治疗30 d死亡的预测价值。结果 92株肺炎链球菌菌株中,耐药率最高的3种抗菌药物分别为复方新诺明、红霉素、四环素,敏感率最高的3种抗菌药物分别为左氧氟沙星、力奈唑胺、万古霉素。治疗30 d患儿死亡率为17.39%。死亡组、非死亡组并发脓毒性休克、合并低白蛋白血症、起病时APACHEⅡ评分及血清CRP、PCT、mNAP、Presepsin、TREM-1水平的分布差异均有统计学意义(P<0.05);性别、年龄、基础疾病的分布差异均无统计学意义(P>0.05)。ROC曲线显示,血清mNAP、Presepsin、TREM-1水平对肺炎链球菌血流感染患儿的死亡风险均有早期预测价值。结论 mNAP、Presepsin、TREM-1水平对肺炎链球菌血流感染患儿的死亡风险具有早期预警价值,可能在日后患儿早期病情评估及治疗体系完善方面具有一定价值。Objective To analyze the survival conditions of children with Streptococcus pneumoniae bloodstream infection and early predictive value of alkaline phosphatase on the neutrophils membrane surface(mNAP),soluble leukocyte differentiation antigen 14 subtype(Presepsin) and serum triggering receptor expressed on myeloid cells-1(TREM-1).Methods Ninety two children with Streptococcus pneumoniae bloodstream infection admitted to a hospital from January 2018 to December 2019 were subject to the blood culture of pathogenic bacteria, and the antimicrobial resistance and sensitivity of antibacterial agents were determined.All admitted childrene were divided into the death group(n=16) and non-death group(n=76) based on the survival condition after the 30-day treatment, independent risk factors for recent death of patients were analyzed by single factor and multi-factor analysis.The receiver operating characteristic curve(ROC) was used to analyze the predictive value of early mNAP,Presepsin and TREM-1 levels in patients to the 30 day-death.Results In the 92 strains of Streptococcus pneumoniae,sulfamethoxazole-trimethoprim(SMZ-TMP),erythromycin and tetracycline were the top three antibacterial agents with maximum drug resistance rate;and levofloxacin, linezolid and vancomycin were the top three antibacterial agent with maximum sensitivity rate.The mortality rate for 30-day treatment was 17.39%.The difference in the level distribution of concurrent septic shock, associated hypoalbuminemia level, APACHEⅡ score and serum C-reactive protein(CRP),procalcitonin(PCT),mNAP,Presepsin, as well as TREM-1 between the death group and the non-death group was statistically significant(P<0.05);there was no statistically significant difference in the distribution of sex, age, and underlying diseases(P>0.05).ROC curve showed that serum mNAP,Presepsin and TREM-1 level have early predictive value on the death risk in children with Streptococcus pneumoniae bloodstream infection.Conclusion The levels of mNAP,Presepsin and TREM-1 of children with S

关 键 词：肺炎链球菌血流感染 耐药性 生存情况 mNAP Presepsin TREM-1 

分 类 号：R378.12[医药卫生—病原生物学] R563.1[医药卫生—基础医学]