肝硬化伴上消化道出血医院感染患者病原学分布特征及血清PCT等指标对其早期预测价值分析  

Analysis of pathogenic distribution characteristics and early predictive value of serum PCT and other indicators in patients with cirrhosis with upper gastrointestinal bleeding hospital infection

作　　者：赵扣玲 张卫平 董艳 ZHAO Kou-ling;ZHANG Wei-ping;DONG Yan(Comprehensive ICU of Shangqiu Municipal Hospital,Shangqiu 476100,China)

机构地区：[1]商丘市立医院综合ICU,河南商丘476100

出　　处：《黑龙江医药科学》2023年第5期35-37,共3页Heilongjiang Medicine and Pharmacy

基　　金：河南省医学科技攻关计划联合共建项目,编号:LHGJ20200936。

摘　　要：目的:探讨肝硬化伴上消化道出血医院感染患者病原学分布特征及血清PCT等指标对其的早期预测价值。方法:选取商丘市立医院202例肝硬化同时出现上消化道出血的患者,回顾性分析患者感染率以及病原学分布特征,检测其血清里面的PCT、CRP、白细胞计数浓度水平,并采用ROC分析其在预测感染中的价值。结果:202例患者中有40例出现了医院感染,感染率为19.8%,最易感染部位是呼吸道52.50%;感染者的体液里面鉴定出了病原菌共51株,其中革兰阴性菌26株占50.98%、革兰阳性菌19株占37.25%、真菌6株占11.76%;感染者合并基础病占比、Childpugh分级(C级)占比、PCT、CRP及白细胞计数水平比较均显著高于非感染者(P<0.05);血清PCT、CRP及白细胞计数联合应用在肝硬化同时出现上消化道出血患者发生医院感染预测中的AUC为0.949,高于PCT(0.847)、CRP(0.863)、白细胞计数(0.844)单独检测。结论:肝硬化伴上消化道出血患者易发生呼吸道感染,主要致病菌是革兰阴性菌,血清PCT、CRP和白细胞计数均升高,联合检测上述指标可作为预测此类患者是否发生医院感染。Objective:To investigate the etiological distribution characteristics of nosocomial infection in invalids with upper gastrointestinal hemorrhage and liver cirrhosis and the early predictive value of serum PCT.Methods:202 invalids with liver cirrhosis complicated with upper gastrointestinal hemorrhage in Shangqiu Municipal Hospital were selected.The infection rate and etiological distribution characteristics were retrospectively analyzed.The serum procalcitonin(PCT),C-reactive protein(CRP)and white blood cell count levels were measured.The ROC was used to analyze the clinical value of these indicators in early prediction of infection.Results:There were 40 cases of nosocomial infection in 202 invalids with liver cirrhosis complicated with upper gastrointestinal hemorrhage,the infection rate was 19.8%,and the most susceptible site of infection was respiratory tract 52.50%.51 strains of pathogenic bacteria were identified by body fluid culture in invalids with infection,including 26 strains of gram-negative bacteria 50.98%,19 strains of gram-positive bacteria 37.25%and 6 strains of fungi 11.76%.The proportion of underlying diseases,Child pugh classification(grade C),PCT,CRP and white blood cell count were significantly higher in invalids with infection than in those without infection(P<0.05).The area under the curve of serum PCT,CRP and white blood cell count in invalids with liver cirrhosis complicated with upper gastrointestinal hemorrhage was 0.949,which was greater than PCT(0.847),CRP(0.863),and white blood cell count(0.844).Conclusions:Nosocomial infection in invalids with liver cirrhosis complicated with upper gastrointestinal hemorrhage is prone to respiratory tract infection.The main pathogen is gram-negative bacteria.Serum PCT,CRP and white blood cell count are increased.Combined detection of PCT,CRP and white blood cell count can be used as a sensitive indicator to predict nosocomial infection in invalids with liver cirrhosis complicated with upper gastrointestinal hemorrhage.

关 键 词：肝硬化伴上消化道出血 医院感染 病原学分布特征 降钙素原 C反应蛋白 早期预测价值 

分 类 号：R575.2[医药卫生—消化系统] R573.2[医药卫生—内科学]