血清PCT与CRP和sTREM-1对COPD患者下呼吸道铜绿假单胞菌感染与定植的诊断价值  

Diagnostic value of serum PCT,CRP and sTREM-1on the infection and colonization of Pseudomonas aeruginosain the lower respiratory tract of patients with COPD

作　　者：刘敏[1] 袁丹 王柏乔 宋玮[1] 张纯萍[3] LIU Min;YUAN Dan;WANG Bo-qiao;SONG Wei;ZHANG Chun-ping(Tianjin Fifth Central Hospital,Tianjin 300450,China;不详)

机构地区：[1]天津市第五中心医院药剂科,天津300450 [2]辽宁省东港市中医院药剂科,辽宁东港118300 [3]海南医学院第一附属医院药剂科,海南海口570102

出　　处：《中华医院感染学杂志》2021年第19期2983-2987,共5页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金青年基金项目(819QN368)。

摘　　要：目的研究血清降钙素原(PCT)、C-反应蛋白(CRP)、髓系细胞表达的触发受体-1(sTREM-1)水平对慢性阻塞性肺炎(COPD)患者下呼吸道铜绿假单胞菌感染与定植的鉴别诊断价值及铜绿假单胞菌的耐药性。方法回顾性选取天津市第五中心医院2018年11月-2019年12月收治的136例成人COPD患者临床资料,根据铜绿假单胞菌感染与定植划分为感染组和定植组,同时选取其他细菌感染患者作为对照组,感染组∶定植组∶对照组=43∶45∶48,所有患者清晨空腹抽取肘静脉全血5ml,比较三组PCT、CRP、sTREM-1并探究彼此之间的相关性。比较和绘制PCT、CRP、sTREM-1及其联合作用的受试者工作特征(ROC)曲线相关参数。同时分析COPD患者下呼吸道铜绿假单胞菌耐药性。结果感染组、定植组PCT、CRP、sTREM-1均高于对照组(P<0.05);sTREM-1、PCT、CRP等三指标间均呈两两正相关(P<0.05);CRP、PCT、sTREM等三指标均具有较高的诊断价值,AUC(0.95CI)分别为0.738(0.627~0.869)、0.755(0.646~0.882)、0.764(0.662~0.881);联合应用价值更高,AUC(0.95CI)为0.861(0.793~0.935)。铜绿假单胞菌对替卡西林、头孢曲松、氨苄西林耐药率>60%,对阿米卡星较敏感,哌拉西林、庆大霉素是治疗铜绿假单胞菌感染的一线药物,但其耐药性也分别达到37.50%、32.14%。结论血清PCT、CRP、sTREM-1水平单一指标均可在一定程度上鉴别COPD患者下呼吸道铜绿假单胞菌感染与定植,三指标进行联合诊断其应用价值更高。铜绿假单胞菌耐药性较高,尤其是针对替卡西林、氨苄西林,临床应该高度重视。OBJECTIVE To study the differential diagnosis value of serum procalcitonin(PCT),C-reactive protein(CRP),and trigger receptor-1(sTREM-1)levels expressed by myeloid cells on the infection and colonization of Pseudomonas aeruginosain the lower respiratory tract of patients with chronic obstructive pneumonia(COPD),and the drug resistance of P.aeruginosa.METHODS The clinical data of 136adult COPD patients admitted to Tianjin Fifth Central hospital from Nov.2018to Dec.2019were retrospectively selected and divided into infection group and colonization group according to P.aeruginosa infection and colonization.At the same time,patients with other bacterial infections were selected as the control group.The ratio of patients in the infection group,colonization group,and control group was 43∶45∶48,and 5ml of cubital vein whole blood was extracted from all patients in the morning on an empty stomach.The PCT,CRP,and sTREM-1among the three groups were compared,and the correlation between them was explored.The receiver characteristic curve(ROC curve)related parameters of PCT,CRP,sTREM-1and their combined effects were compared and drawn.At the same time,the drug resistance of P.aeruginosain the lower respiratory tract of COPD patients was analyzed.RESULTS The levels of PCT,CRP,and sTREM-1in infection group and colonization group were significantly higher than those in control group(P<0.05).The sTREM-1,PCT and CRP were positively correlated(P<0.05).CRP,PCT and strem had high diagnostic value,and the AUC(0.95CI)were 0.738(0.627-0.869),0.755(0.646-0.882),and 0.764(0.662-0.881),respectively,and combined application value was higher,with the AUC(0.95CI)of 0.861(0.793-0.935).The resistance rate of P.aeruginosa to ticarcillin,ceftriaxone and ampicillin was more than 60%,and it was more sensitive to amikacin.Piperacillin and gentamicin were the first-line drugs to treat P.aeruginosa infection,but their drug resistance also reached 37.50%and 32.14%,respectively.CONCLUSIONSingle index of serum PCT,CRP and sTREM-1levels could distingui

关 键 词：血清降钙素原 C-反应蛋白 髓系细胞表达的触发受体-1 慢性阻塞性肺炎 铜绿假单胞菌 鉴别诊断 耐药性 

分 类 号：R446[医药卫生—诊断学]