肝素结合蛋白对接受体外膜肺氧合治疗患者院内继发感染的诊断价值  

Heparin-binding protein for the diagnostic value of nosocomial secondary infections in patients undergoing extracorporeal membrane oxygenation

作　　者：方红龙[1] 赵俊杰 汪叶松[3] 陈卫挺 於佳飞 罗建[1] 张伟文[1] 张根生[3,6] Fang Honglong;Zhao Junjie;Wang Yesong;Chen Weiting;Yu Jiafei;Luo Jian;Zhang Weiwen;Zhang Gensheng(Department of Critical Care Medicine,Quzhou People's Hospital,Quzhou 324000,China;The Third Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Critical Care Medicine,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Emergency,the First People’s Hospital of Linhai,Taizhou 317000,China;Department of Critical Care Medicine,Haiyan People’s Hospital,Jiaxing 314399,China;Key Laboratory of Multiple Organ Failure(Zhejiang University),Ministry of Education,Hangzhou 310009,China)

机构地区：[1]衢州市人民医院重症医学科,衢州324000 [2]浙江中医药大学附属第三临床医学院,杭州310053 [3]浙江大学医学院附属第二医院重症医学科,杭州310009 [4]临海市第一人民医院急诊科,台州317000 [5]海盐县人民医院重症医学科,嘉兴314399 [6]多脏器衰竭预警与干预教育部重点实验室(浙江大学),杭州310009

出　　处：《国际流行病学传染病学杂志》2024年第3期169-173,共5页International Journal of Epidemiology and Infectious Disease

基　　金：浙江省医药卫生科技计划(2023KY1296);衢州市科技计划(2022K71)。

摘　　要：目的探讨肝素结合蛋白(heparin-binding protein, HBP)对接受体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)治疗患者发生院内继发感染的诊断价值。方法单中心回顾性分析2020年1月至2023年1月收治衢州市人民医院重症医学科并接受ECMO治疗的患者, 根据ECMO运行期间是否发生感染分成感染组和非感染组, 收集并分析两组患者的一般人口学资料、化验检查、感染类型以及预后等指标。ECMO治疗开始后每日抽血检测, HBP取确诊院内感染当日、确诊院内感染前24 h、48 h和72 h四个时间点的检测结果进行动态分析。采用受试者工作曲线(ROC)评价HBP对ECMO患者院内感染的诊断价值。结果共66例接受ECMO的患者纳入研究, 其中感染组患者23例, 占34.85%。感染组在ECMO运行后发生院内感染的中位时间为7 d, 以呼吸道感染最为多见(52.17%, 12/23), 28 d存活患者数为5例(21.74%, 5/23), 明显低于非感染组(χ^(2)=3.908, P=0.048)。与非感染组相比, 感染组患者在确诊院内感染当日[(42.08±19.15) ng/mLvs.(16.76±6.31)ng/mL,t=7.943,P<0.001]及确诊院内感染前24 h[(33.13±14.47)ng/mLvs.(16.61±5.71)ng/mL,t=7.020,P<0.001]的HBP水平明显升高。HBP诊断ECMO患者院内感染的曲线下面积(AUC)为0.873。当HBP ≥22.98 ng/mL时, 诊断ECMO患者发生院内感染的灵敏度为85.0%, 特异性为80.4%。结论接受ECMO治疗的患者发生院内感染比例高达1/3, 一旦发生, 明显影响预后。患者接受ECMO治疗后, 动态观察HBP具有重要的意义, 当急性升高达22.98 ng/mL及以上对院内感染具有较好的诊断价值。Objective To investigate the diagnostic value of heparin-binding protein(HBP)for hospital-acquired secondary infection in patients undergoing extracorporeal membrane oxygenation(ECMO).Methods A single-center retrospective analysis was conducted on patients admitted to Intensive Care Unit of Quzhou People’s Hospital and receiving ECMO from January 2020 to January 2023.Patients were divided into infection and non-infection groups based on the occurrence of infection during ECMO operation.Demographic data,laboratory tests,infection types,and prognosis indicators of the two groups were collected and analyzed.Blood samples were collected daily after the start of ECMO treatment to dynamically analyze HBP levels at the time of confirmed nosocomial infection,24,48 and 72 hours before confirmation.The diagnostic value of HBP for nosocomial infection in patients receiving ECMO was evaluated using receiver operating characteristic(ROC)curves.Results A total of 66 patients receiving ECMO were included in this study,with 23 patients(34.85%)in the infection group.The median time for nosocomial infections after ECMO operation in the infection group was 7 days,with respiratory tract infections being the most common(52.17%,12/23).Compared to the non-infection group,the 28-day survival rate(21.74%,5/23)significantly decreased in the infection group(χ^(2)=3.908,P=0.048).Compared to the non-infection group,HBP levels were significantly elevated in the infection group on the day of confirmed nosocomial infection[(42.08±19.15)ng/mL vs.(16.76±6.31)ng/mL,t=7.943,P<0.001]and 24 hours before confirmation[(33.13±14.47)ng/mL vs.(16.61±5.71)ng/mL,t=7.020,P<0.001].The area under the curve(AUC)value of HBP was 0.873.When HBP level was≥22.98 ng/mL,the sensitivity for diagnosing nosocomial infections in ECMO patients was 85.0%,and the specificity was 80.4%.Conclusions The proportion of nosocomial infection among patients receiving ECMO is as high as 1/3.Once it occurs,it significantly affects the prognosis.Dynamic observation of HBP is

关 键 词：交叉感染 肝素结合蛋白 体外膜肺氧合 诊断价值 

分 类 号：R459.7[医药卫生—急诊医学]