不同病原学结果血流感染脓毒症患者PT、NLR、PCT/ALB的变化及其与预后的关系研究  

Study on the Changes of PT,NLR,PCT/ALB and Their Relationship with Prognosis in Sepsis Patients with Different Etiological Results of Bloodstream Infections

作　　者：周子阳 唐建国[1] 徐丹[1] 崔宇慧[1] 黄力鸥[1] 尹丽萍 吴春荣[1] ZHOU Zi-yang;TANG Jian-guo;XU Dan;CUI Yu-hui;HUANG Li-ou;YIN Li-ping;WU Chun-rong(Department of Critical Care Medicine,Shanghai Fifth People's Hospital Affiliated to Fudan University,Shanghai,201100,China)

机构地区：[1]复旦大学附属上海市第五人民医院重症医学科,上海201100

出　　处：《现代生物医学进展》2024年第5期858-862,903,共6页Progress in Modern Biomedicine

基　　金：上海市科技委员会科研项目(18411950600)。

摘　　要：目的:探讨不同病原学结果血流感染(BSI)脓毒症患者凝血酶原时间(PT)、中性粒细胞/淋巴细胞比值(NLR)、降钙素原/白蛋白(PCT/ALB)的变化及其与预后的关系。方法:选取2021年1月~2023年3月复旦大学附属上海市第五人民医院收治的BSI脓毒症患者130例,根据不同病原学结果分为真菌组11例、革兰阳性菌(G+菌)组49例、革兰阴性菌(G-菌)组70例。根据28d临床结局将BSI脓毒症患者分为死亡组36例和存活组94例。检测并计算PT、NLR、PCT/ALB。采用多因素Logistic回归分析影响BSI脓毒症患者预后的因素,采用受试者工作特征(ROC)曲线分析PT、NLR、PCT/ALB对BSI脓毒症患者死亡的预测价值。结果:G-菌组PT长于真菌组、G+菌组,NLR、PCT/ALB高于真菌组、G+菌组(P<0.05),真菌组与G+菌组PT、NLR、PCT/ALB比较无差异(P>0.05)。多因素Logistic回归分析显示脓毒性休克、PT延长,序贯器官衰竭评估(SOFA)评分升高、急性生理和慢性健康评估Ⅱ(APACHEⅡ)评分升高、NLR升高、PCT/ALB升高为影响BSI脓毒症患者预后的独立危险因素(P<0.05)。ROC曲线分析显示PT、NLR、PCT/ALB联合预测BSI脓毒症患者死亡的曲线下面积为0.897,大于PT、NLR、PCT/ALB单独预测(P<0.05)。结论:相比真菌和G+菌,G-菌BSI脓毒症患者PT、NLR、PCT/ALB明显升高,且PT、NLR、PCT/ALB升高是影响BSI脓毒症患者预后的独立危险因素,三者联合对BSI脓毒症患者预后的预测价值较高。Objective:To investigate the changes of prothrombin time(PT),neutrophil/lymphocyte ratio(NLR),and procalcitonin/albumin(PCT/ALB)in sepsis patients with different etiological results of bloodstream infection(BSI)and their relationship with prognosis.Methods:130 sepsis patients with BSI admitted to the Shanghai Fifth People's Hospital Affiliated to Fudan University from January 2021 to March 2023 were selected,and they were divided into fungal group with 11 cases,gram-positive bacteria(G+bacteria)group with 49 cases and gram-negative bacteria(G-bacteria)group with 70 cases according to different etiological results.Sepsis patients with BSI were divided into death group with 36 cases and survival group with 94 cases according to the 28d clinical outcome.The PT,NLR,PCT/ALB were detected and calculated.Multivariate Logistic regression was used to analyze the factors affecting the prognosis of sepsis patients with BSI,and receiver operating characteristics(ROC)curve was used to analyze the predictive value of PT,NLR,PCT/ALB in predicting death in sepsis patients with BSI.Results:The PT of G-bacteria group was longer than that of fungal group and G+bacteria group,and the NLR and PCT/ALB were higher than those of fungal group and G+bacteria group(P<0.05).There were no differences in PT,NLR and PCT/ALB between fungal group and G+bacteria group(P>0.05).Multivariate Logistic regression analysis showed that septic shock,PT prolongation,Sequential Organ failure assessment(SOFA)score elevated,Acute physiological and Chronic Health AssessmentⅡ(APACHEⅡ)score elevated,NLR elevated,PCT/ALB elevated were independent risk factors for the prognosis of sepsis patients with BSI(P<0.05).ROC curve analysis showed that the area under the curve of PT,NLR and PCT/ALB combined predicted the death of sepsis patients with BSI was 0.897,which was larger than that predicted by PT,NLR and PCT/ALB alone(P<0.05).Conclusion:Compare with fungi and G+bacteria,PT,NLR and PCT/ALB of G-bacteria in sepsis patients with BSI are significantly elevated,a

关 键 词：脓毒症 血流感染 病原学 凝血酶原时间 中性粒细胞/淋巴细胞 降钙素原/白蛋白 预后 

分 类 号：R631.2[医药卫生—外科学]