VAP患者感染病原菌的调查和PCT、CRP水平的变化及诊断价值  

The types of pathogenic bacteria and the changes of PCT and CRP levels in patients with VAP and their diagnostic value

作　　者：夏进[1] 陈培[1] 王丹[1] 官和立[1] 周晖[1] XIA Jin;CHEN Pei;WANG Dan;GUAN He-li;ZHOU Hui(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Chengdu University,Chengdu,Sichuan 610081,China)

机构地区：[1]成都大学附属医院呼吸与危重症医学科,四川成都610081

出　　处：《中国病原生物学杂志》2022年第9期1086-1089,共4页Journal of Pathogen Biology

基　　金：成都大学教学改革项目(No.CDJGB2019088,CDJGB2019100)。

摘　　要：目的调查呼吸机相关性肺炎(VAP)患者感染病原菌的分布,探讨PCT、CRP水平的变化及其诊断价值。方法2019年6月-2021年6月于我院行机械通气治疗的328例患者,根据是否发生VAP分为VAP组、非VAP组。采用全自动细菌鉴定仪检测VAP患者痰液或支气管液等标本的病原菌,分析VAP患者病原菌特点。检测并比较两组患者的血清PCT、CRP炎症因子的水平,采用ROC曲线分析血清PCT、CRP诊断VAP的效能。结果328例患者中VAP患者144例(43.90%),共检查出188株病原菌,其中革兰阴性菌130株(69.15%),革兰阳性菌48株(25.53%),真菌10株(5.32%)。主要感染病原菌为鲍曼不动杆菌(40株)、肺炎克雷伯菌(31株)、大肠埃希菌(23株)。VAP组的血清PCT(5.16±1.52)ng/ml、CRP(18.76±5.23)mg/L水平以及CPIS评分(6.36±0.73)分明显高于非VAP组血清PCT(0.44±0.13)ng/ml、CRP(5.42±1.53)mg/L水平以及CPIS评分(3.82±0.58)分,差异有统计学意义(均P<0.05)。Pearson相关分析显示,血清PCT、CRP水平均与CPIS评分呈正相关性(r=0.496、0.472,均P<0.05)。血清PCT诊断VAP的AUC为0.772(95%CI:0.712~0.835),截断值为4.46 ng/ml。血清CRP诊断VAP的AUC为0.758(95%CI:0.694~0.826),截断值为11.66 mg/L。血清PCT、CRP联合诊断VAP的AUC为0.865(95%CI:0.802~0.914),明显高于单独诊断(P<0.05)。结论VAP患者感染病原菌主要为革兰阴性菌,VAP患者血清PCT、CRP处于高表达状态,两者联合检测可提高VAP诊断效能。Objective To investigate the distribution of pathogens in patients with ventilator-associated pneumonia(VAP),and to explore the changes of PCT and CRP levels and their diagnostic value.Methods 328 patients who underwent mechanical ventilation in our hospital from June 2019 to June 2021 were divided into VAP group and non VAP group according to whether VAP occurred or not.The medical records of patients were collected,including gender,age,mechanical ventilation,accompanying diseases,pathogen culture results,drug sensitivity test results,etc.5ml venous blood was collected and cultured at 35℃for 72 hours by BacT/Alert3D automatic blood culture instrument.Collect 1ml of sputum or bronchial fluid,dissolve them in 99 ml of sterilized normal saline,shake them well,and culture them in BSCⅡa2-1102 automatic bacterial incubator at 35℃for 48 hours.The pathogens in saliva or sputum of VAP patients were detected by automatic bacterial identification instrument.The degree of pulmonary infection was evaluated by CPIs score.In addition,4 ml of venous blood was collected,centrifuged at 3500 r/min for 20 min,and the supernatant was taken.The level of PCT was measured by 7600-020 automatic biochemical instrument and Cobas E601 automatic electrochemiluminescence instrument.The characteristics of pathogens in VAP patients were analyzed.The levels of serum PCT,CRP and inflammatory factors were compared between the two groups,and the efficacy of serum PCT and CRP in the diagnosis of VAP was analyzed by ROC curve.Results Among 328 patients,144(43.90%)were VAP patients.188 strains of pathogens were detected,including 130(69.15%)gram negative bacteria,48(25.53%)gram positive bacteria and 10(5.32%)fungi.The main pathogens were Acinetobacter baumannii(40 strains),Klebsiella pneumoniae(31 strains)and Escherichia coli(23 strains).The levels of serum PCT(5.16±1.52)ng/ml,CRP(18.76±5.23)mg/L and CPIs score(6.36±0.73)in VAP group were significantly higher than those in non VAP group(0.44±0.13)ng/ml,CRP(5.42±1.53)mg/L and CPIs score(3.8

关 键 词：呼吸机相关性肺炎 降钙素原 C-反应蛋白 

分 类 号：R378[医药卫生—病原生物学]