老年心力衰竭合并肺炎患者病原菌分布、炎性因子变化及预后分析  

Distribution of Pathogenic Bacteria,Changes of Inflammatory Factors and Prognosis Analysis of Elderly Patients with Heart Failure Complicated with Pneumonia

作　　者：段咏梅[1] 刘成[1] 安园园[2] 黄杭 DUAN Yongmei;LIU Cheng;AN Yuanyuan;HUANG Hang(Department of Coronary Heart Disease,Cardiovascular Disease Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Comprehensive Internal,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Emergency Medicine,Shanghai Fengxian District Central Hospital,Shanghai 201406,China)

机构地区：[1]新疆医科大学第一附属医院心血管疾病中心冠心病二科,乌鲁木齐市830054 [2]新疆医科大学第一附属医院综内一科,乌鲁木齐市830054 [3]上海市奉贤区中心医院急诊医学科,上海市201406

出　　处：《中国分子心脏病学杂志》2023年第1期5172-5176,共5页Molecular Cardiology of China

基　　金：上海市卫生和计划生育委员会科研课题(20194Y0032)。

摘　　要：目的分析老年心力衰竭(心衰)合并肺炎患者病原菌分布、炎性因子变化及预后情况。方法收集2016年2月至2021年2月收治的心衰患者105例,其中心衰患者41例(心衰组),心衰合并肺炎患者64例(心衰合并肺炎组);根据肺部CT及痰培养结果,将其分为感染组(n=54)和非感染组(n=51)。另选取同期健康体检者38例作为对照组。统计老年心衰合并肺炎患者病原菌分布情况,分析不同人群中炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、降钙素原(PCT)]表达情况;对心衰合并肺炎组患者进行随访,随访截止至2022年2月,了解患者预后情况。记录心衰组、心衰合并肺炎组不良事件发生情况,对比不同预后患者TNF-α、IL-6、PCT表达情况。结果64例心衰合并肺炎患者中共检出致病菌98株,其中革兰氏阴性菌74株(75.51%)、革兰氏阳性菌23株(23.47%);三组中TNF-α、IL-6、PCT表达水平从高到低为:感染组>非感染组>对照组,差异有统计学意义(P<0.05);心衰合并肺炎组不良事件发生率为21.87%,明显高于心衰组(7.32%),差异有统计学意义(P<0.05);不良预后患者TNF-α、IL-6、PCT表达水平明显高于预后良好者,差异有统计学意义(P<0.05)。经logistic回归分析,高等级心功能分级和TNF-α、IL-6、PCT升高是影响心衰合并肺炎患者预后不良的独立危险因素(P<0.05)。结论老年心衰合并肺炎患者的病原菌以革兰氏阴性菌为主,肺炎可导致患者TNF-α、IL-6、PCT炎性因子进一步升高,加重患者病情,影响预后。Objective To analyze the distribution of pathogenic bacteria,changes in inflammatory factors and prognosis in elderly patients with heart failure complicated with pneumonia.Methods A total of 105 patients with heart failure admitted to our hospital from February 2016 to February 2021 were collected,including 41 patients with heart failure(heart failure group)and 64 patients with pneumonia(heart failure combined with pneumonia group).According to the results of lung CT and sputum culture,they were divided into infection group(n=54)and non-infection group(n=51).Another 38 cases of physical examination in the same period were selected as the control group.The distribution of pathogenic bacteria in elderly patients with heart failure complicated with pneumonia was counted,and the inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin 6(IL-6),and procalcitonin(PCT)different populations were analyzed.The patients with heart failure complicated with pneumonia group were followed up until February 2022,the prognosis of the patients was understood.The incidence of adverse events in the heart failure group and the heart failure combined with pneumonia group was recorded,and the expressions of TNF-α,IL-6 and PCT in patients with different prognosis were compared.Results 98 strains of pathogenic bacteria were detected in 64 patients with heart failure complicated with pneumonia,including 74 strains(75.51%)of gram-negative bacteria and 23 strains(23.47%)of gram-positive bacteria;the expression levels of TNF-α,IL-6,PCT from high to low were:infection group>non-infection group>control group,the difference was statistically significant(P<0.05);the incidence of adverse events in the heart failure with pneumonia group was 21.87%,which was significantly higher than that in the heart failure group(7.32%),and the difference was statistically significant(P<0.05);the expression levels of TNF-α,IL-6 and PCT in patients with poor prognosis were significantly higher than those in patients with good prognosis,and the

关 键 词：老年患者 心衰合并肺炎 病原菌分布 炎性因子 预后 

分 类 号：R541.6[医药卫生—心血管疾病] R563.1[医药卫生—内科学]