缺血性脑卒中合并肺部感染患者病原菌分布及血清sCD14-ST、ADA水平变化的临床意义  

Distribution of pathogenic bacteria in patients with ischemic stroke complicated with pulmonary infection and clinical significance of changes of serum sCD14-ST and ADA levels

作　　者：颜晓娇 李柏新[1] YAN Xiaojiao;LI Baixin(Rehabilitation Center,Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning,110000,China)

机构地区：[1]中国医科大学附属盛京医院康复中心,辽宁沈阳110000

出　　处：《中国病原生物学杂志》2023年第12期1457-1461,1465,共6页Journal of Pathogen Biology

摘　　要：目的探讨缺血性脑卒中(ICS)患者合并肺部感染(PI)病原菌分布情况及血清可溶性白细胞分化抗原14亚型(sCD14-ST)、腺苷脱氨酶(ADA)水平变化的临床意义。方法选取2022年1月至2023年1月本院收治的92例ICS合并PI患者为合并组,同时期本院收治的92例ICS患者(未合并PI)为ICS组。对合并组患者进行痰培养,记录其病原菌分布情况。采用酶联免疫吸附法(ELISA)检测两组患者血清sCD14-ST、ADA水平。采用多因素Logistic回归分析导致ICS患者并发PI的影响因素。采用受试者工作特征(ROC)曲线评价血清sCD14-ST、ADA水平对ICS患者并发PI的诊断效能。采用临床肺部感染评分(CPIS)评价合并组患者肺部感染程度,并采用Spearman相关性分析ICS合并PI患者血清sCD14-ST、ADA水平与CPIS评分之间的相关性。结果92例ICS合并PI患者共检出125株病原菌:革兰阴性菌74株(59.20%),占比最高的前三位分别是铜绿假单胞菌(18.40%)、鲍曼不动菌(14.40%)、肺炎克雷伯菌(9.60%);革兰阳性菌46株(36.80%),占比最高的前三位分别是金黄色葡萄球菌(12.80%)、表皮葡萄球菌(8.80%)、肺炎链球菌(5.60%);真菌5株(4.00%),均为白假丝酵母菌。合并组患者血清sCD14-ST、ADA水平均高于ICS组(P<0.05)。合并组患者中合并低蛋白血症、卧床时间≥15 d、有侵入性操作、吞咽障碍者占比及PCT、hs-CRP、TNF-α水平均高于ICS组(P<0.05)。Logistic回归分析表示,卧床时间≥15 d、有侵入性操作、吞咽障碍、PCT、hs-CRP、TNF-α、sCD14-ST、ADA水平均是导致ICS患者并发PI的危险因素(P<0.05)。ROC分析结果表示,血清sCD14-ST、ADA水平联合诊断ICS患者合并PI的曲线下面积(AUC)明显大于二者单独诊断的AUC(Z=2.738,P=0.006;Z=3.455,P=0.01)。Spearman相关性分析结果表示,ICS合并PI患者的血清sCD14-ST、ADA水平均与CPIS评分呈显著正相关(rs=0.586、0.575,P<0.01)。结论ICS合并PI患者病原菌分布以革兰阴性菌为主,sCD14-ST�Objective To investigate the distribution of pathogenic bacteria in patients with ischemic stroke(ICS)complicated with pulmonary infection(PI)and the clinical significance of changes of serum soluble leukocyte differentiation antigen 14 subtype(sCD14-ST)and adenosine deaminase(ADA)levels.Methods From January 2022 to January 2023,92 patients with ICS complicated with PI admitted to our hospital were regarded as the combination group,while 92 ICS patients(without PI)admitted to our hospital were as the ICS group.Sputum culture was performed on patients in the combination group,and the distribution of pathogenic bacteria was recorded.Enzyme-linked immunosorbent assay(ELISA)was applied to detect serum sCD14-ST and ADA levels of patients in two groups.Multivariate logistic regression was applied to analyze the influencing factors of PI in ICS patients.Receiver operating characteristic(ROC)curve was applied to evaluate the diagnostic efficacy of serum sCD14-ST and ADA levels in patients with ICS complicated with PI.Clinical Pulmonary Infection Score(CPIS)was applied to evaluate the degree of pulmonary infection in patients in the combination group,Spearman correlation was applied to analyze the correlation between serum sCD14-ST,ADA levels and CPIS score in patients with ICS complicated with PI.Results A total of 125 strains of pathogenic bacteria were detected in 92 patients with ICS and PI:74 strains(59.20%)were Gram-negative bacteria,and the top three were Pseudomonas aeruginosa(18.40%),Acinetobacter baumannii(14.40%),and Klebsiella pneumoniae(9.60%);46 strains(36.80%)were Gram-positive bacteria,and the top three were Staphylococcus aureus(12.80%),S.epidermidis(8.80%)and S.pneumoniae(5.60%);5 strains(4.00%)were fungi,all of which were Candida albicans.The levels of serum sCD14-ST and ADA in the combination group were higher than those in the ICS group(P<0.05).The proportions of hypoproteinemia,bed rest time≥15 days,invasive procedures,dysphagia,and the levels of PCT,hs-CRP,TNF-αin the combination group were highe

关 键 词：缺血性脑卒中 肺部感染 病原菌分布 可溶性白细胞分化抗原14亚型 腺苷脱氨酶 诊断 

分 类 号：R378[医药卫生—病原生物学]