心脏术后行中心静脉置管患者的感染病原分布和PD-1、hs-CRP、IL-18水平变化及临床意义  

Distribution of infectious pathogens,changes of PD-1,hs-CRP,IL-18 levels and its clinical significance in patients with central venous catheterization infection after cardiac surgery

作　　者：郭兵兵[1] 高杰[1] 黄白艳 GUO Bingbing;GAO Jie;HUANG Baiyan(Department of Infection Prevention and Control,Zhengzhou Seventh People's Hospital,Zhengzhou,Henan,China,450000)

机构地区：[1]郑州市第七人民医院感染防控科,河南郑州450000

出　　处：《分子诊断与治疗杂志》2023年第4期682-685,689,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河南省医学科技攻关计划项目(LHGJ201917023)。

摘　　要：目的 分析心脏术后行中心静脉置管(CVC)患者的感染病原分布及血清程序性细胞死亡受体(PD-1)、超敏C反应蛋白(hs-CRP)、白细胞介素-18(IL-18)的水平变化和临床意义。方法 选取2017年2月至2022年9月郑州市第七人民医院收治的793例心脏手术行中心静脉置管的患者为研究对象,将其纳入观察组,另选取同期体检的751名健康人群作为对照组。对比两组血清PD-1、hs-CRP、IL-18水平,根据是否发生术后中心静脉置管感染,将观察组患者分为发生感染组和未发生感染组,采用Logistic回归分析心脏术后中心静脉置管感染的影响因素。结果 CVC感染细菌培养的病原体分布以革兰氏阴性杆菌多见,占65.22%(15/23),革兰阳性球菌占30.43%(7/23),真菌占4.35%(1/23)。观察组患者血清PD-1、hs-CRP、IL-18水平高于对照组,差异具有统计学意义(P<0.05)。观察组有23例患者发生CVC感染,770例未发生感染。发生感染组与未感染组患者的性别、高血压病史、BMI、导管直径、血小板及白细胞水平比较差异无统计学意义(P>0.05)。发生感染组与未感染组患者年龄、糖尿病史、置管时间、导管管腔及PD-1、hs-CRP、IL-18水平比较,差异具有统计学意义(P<0.05)。Logistic回归分析结果显示,患者年龄≥60岁、导管留置时间≥7 d、导管管腔(多腔)、有糖尿病史、血清PD-1、hs-CRP、IL-18水平是影响心脏术后中心静脉置管感染的独立危险因素(P<0.05)。结论 血清PD-1、hs-CRP、IL-18水平升高是影响患者心脏术后发生中心静脉置管感染的相关因素,通过观察三者水平变化情况,对心脏术后CVC感染的防治具有重要意义。Objective To analyze the distribution of infectious pathogens,changes of serum programmed cell death receptor(PD-1),high-sensitive C-reactive protein(hs-CRP)and interleukin-18(IL-18)levels and its clinical significance in patients with central venous catheterization(CVC)infection after cardiac surgery.Methods 793 patients undergoing cardiac surgery and central venous catheterization who were admitted to Zhengzhou Seventh People's Hospital from February 2017 to September 2022 were selected as the research subjects,and were included in the observation group,in addition,751 healthy people who underwent physical examination during the same period were selected as the control group.The serum levels of PD-1,hs-CRP,and IL-18 were compared between the two groups,according to the occurrence of postoperative central venous catheter infection,the patients in the observation group were divided into the infection group and the non-infection group,and Logistic regression was used to analyze the influencing factors of central venous catheter infection after cardiac surgery.Results The pathogen distribution of bacterial culture in CVC infection was mostly Gram-negative bacilli,accounting for 65.22%(15/23),Gram-positive cocci accounting for 30.43%(7/23),and fungi accounting for 4.35%(1/23).The levels of serum PD-1,hs-CRP and IL-18 in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).23 patients in the observation group developed CVC infection and 770 patients did not develop infection.There were no significant differences in gender,history of hypertension,BMI,catheter diameter,platelet and white blood cell levels between the infection group and the non-infection group(P>0.05).There were statistically significant differences in age,diabetes history,catheterization time,catheter lumen,PD-1,hs-CRP,and IL-18 levels between the infection group and the non-infection group(P<0.05).The results of Logistic regression analysis showed that patients' age ≥ 60 years,ca

关 键 词：中心静脉置管 PD-1 HS-CRP IL-18 

分 类 号：R654.2[医药卫生—外科学]