免疫炎症指标对医院获得性多药耐药鲍氏不动杆菌菌血症预后的预测价值  

Predictive values of immunoinflammatory indicators for the prognosis of hospital-acquired multidrug-resistant Acinetobacter baumannii bacteremia

作　　者：包红[1] 曹定岩 杨松梅[1] 杨波[1] 梅艳芳[1] 刘长飞[1] 李富利[2] 程明艳 BAO Hong;CAO Ding-yan;YANG Song-mei;YANG Bo;MEI Yan-fang;LIU Chang-fei;LI Fu-li;CHENG Ming-yan(Chengde Central Hospital,Chengde,Hebei 067000,China)

机构地区：[1]承德市中心医院,河北承德067000 [2]承德医学院附属医院,河北承德067000

出　　处：《中华医院感染学杂志》2023年第4期512-516,共5页Chinese Journal of Nosocomiology

基　　金：河北省医学科学研究基金资助项目(20170883)。

摘　　要：目的 分析免疫炎症指标对医院获得性多药耐药鲍氏不动杆菌(MDRAB)菌血症预后的诊断价值.方法 选取2019年1月-2021年12月于承德地区住院治疗的106例医院获得性MDRAB菌血症患者作为研究对象,根据发病后28 d死亡情况将患者分为死亡组(49例)和存活组(57例).对两组患者的临床特征及外周血白细胞计数(WBC)、红细胞沉降率(ESR)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)及血清C-反应蛋白(CRP)、降钙素原(PCT)水平进行对比.采用受试者工作特征(ROC)曲线对免疫炎症指标预测患者预后的价值进行分析.结果 死亡组患者合并终末期肾病、接受侵入性操作、应用糖皮质激素、合并感染性休克的比例及发病时急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分均高于存活组(P<0.05);死亡组患者外周血CD_(8)^(+)和血清PCT均高于存活组(P<0.05),外周血CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)均低于存活组(P<0.05).外周血CD_(4)^(+)/CD_(8)^(+)预测患者预后的ROC曲线下面积(AUC)最高(P<0.05),其次为血清PCT(P<0.05).结论 医院获得性MDRAB菌血症患者的免疫炎症指标与其死亡风险具有关联性,特别是外周血CD_(4)^(+)/CD_(8)^(+)和PCT对预后预测有较高的价值.OBJECTIVE To investigate the diagnostic values of immunoinflammatory indicators for the prognosis of hospital-acquired multidrug-resistant Acinetobacter baumannii(MDRAB)bacteremia.METHODS Totally 106 patients with hospital-acquired MDRAB bacteremia hospitalized in Chengde area from Jan.2019 to Dec.2021 were selected as the research subjects and were divided into the death group(49 cases)and the survival group(57 cases)according to the death at 28 d after onset.The clinical characteristics as well as the levels of white blood cell(WBC),erythrocyte sedimentation rate(ESR),CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)in the peripheral blood and the serum levels of C-reactive protein(CRP)and procalcitonin(PCT)of patients were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the values of immunoinflammatory indicators in predicting the prognosis of patients.RESULTS The proportion of patients with end-stage renal disease,invasive procedures,glucocorticoid application,septic shock and the acute physiology and chronic health evaluation II(APACHE II)at presentation in the death group were higher than those in the survival group(P<0.05).The CD,in peripheral blood and the serum PCT level of the patients in the death group were higher than those in the survival group(P<0.05),while the CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)in peripheral bloodwere lower than those in the survival group(P<0.05).The area under ROC curve(AUC)of peripheral blood CD_(4)^(+)/CD_(8)^(+)in predicting the prognosis of the patients was the highest(P<0.05),followed by serum PCT(P<0.05).CONCLUSION The immunoinflammatory indicators of patients with hospital acquired MDRAB bacteremia were correlated with their risk of death,especially the ratio of CD_(4)^(+)/CD_(8)^(+)T lymphocyte in peripheral blood and the level of serum PCT wereofhighvalues fortheprediction of prognosis.

关 键 词：免疫炎症指标 医院感染 多药耐药鲍氏不动杆菌 菌血症 预后 预测价值 

分 类 号：R446[医药卫生—诊断学]