急性白血病患者PICC置管感染病原菌及PCT、ET、NLR、TM联合检测诊断价值  

Distribution of pathogenic bacteria and the diagnostic value of PCT,ET,NLR and TM combined detection in infection after PICC in patients with acute leukemia

作　　者：姚姗姗 郑玮 李艳[1] 于巧 卢婷 孙琛[1] YAO Shan-shan;ZHENG Wei;LI Yan;YU Qiao;LU Ting;SUN Chen(Qingdao Hiser Hospital Affiliated of Qingdao University(Qingdao Traditional Chinese Medicine Hospital),Qingdao,Shandong 266033,China)

机构地区：[1]青岛大学附属青岛市海慈医院(青岛市中医医院)风湿免疫血液科,山东青岛266033

出　　处：《中华医院感染学杂志》2024年第15期2269-2273,共5页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展项目(202003041040)。

摘　　要：目的探讨急性白血病患者经外周静脉置入中心静脉导管(PICC)置管感染致病菌分布、药敏结果及血清降钙素原(PCT)、内毒素(ET)、外周血中性粒细胞/淋巴细胞数比值(NLR)、血浆血栓调节蛋白(TM)联合检测的临床指导价值.方法回顾性分析2020年8月—2023年8月青岛大学附属青岛市海慈医院(青岛市中医医院)收治的152例急性白血病PICC置管患者的临床资料,根据是否发生感染分为感染组(26例)和非感染组(126例);分析急性白血病患者PICC置管感染致病菌分布情况及主要致病菌的药敏结果,比较感染组和非感染组的临床资料、血清PCT、ET、外周血NLR及血浆TM水平,并绘制受试者工作特征(ROC)曲线分析血清PCT、ET、外周血NLR、血浆TM单一及联合检测对急性白血病患者PICC置管感染的诊断价值.结果26例急性白血病PICC置管感染患者共检出菌株34株,其中革兰阴性菌23株(67.65%),革兰阳性菌10株(29.41%),真菌1株(2.94%);感染组血清PCT、ET、外周血NLR、血浆TM水平高于非感染组(P<0.05);ROC曲线分析结果显示,血清PCT、ET、外周血NLR、血浆TM联合诊断急性白血病患者PICC置管感染的曲线下面积(AUC)值为0.931,高于血清PCT、ET、外周血NLR、血浆TM单一检测(P<0.05).结论急性白血病患者PICC置管感染致病菌以革兰阴性菌为主,不同病原菌对抗菌药物的耐药特点不同,其发生与基础疾病史、置管时间、化疗次数、穿刺次数及血清PCT、ET、外周血NLR、血浆TM水平有关,且血清PCT、ET、外周血NLR、血浆TM联合检测的诊断价值更高.OBJECTIVE To investigate the pathogenic bacteria distribution,drug sensitivity of infection after under-went peripherelly inserted central cateter(PICC)in patients with acute leukemia,and to evaluate the clinical guid-ance value of combined detection of serum procalcitonin(PCT),endotoxins(ET),peripheral blood neutrophil/lymphocyte ratio(NLR)and plasma thrombomodulin(TM).METHODS The clinical data of 152 patients with a-cute leukemia PICC placement admitted to Qingdao Hiser Hospital Affiliated of Qingdao University(Qingdao Tra-ditional Chinese Medicine Hospital)from Aug 2020 to Aug 2023 were retrospectively analyzed,and divided into the infection group(26 cases)and the non-infection group(126 cases)according to whether the infection occurred.The distribution of pathogenic bateria of PICC cannula infection and drug sensitivity of the main causative organ-isms were analyzed.The clinical data,levels of serum PCT,ET,peripheral blood NLR and plasma TM in the in-fected group and non-infected group were compared.The diagnostic value of serum levels of PCT,ET,peripheral blood NLR and plasma TM single and combined detection for the diagnosis of PICC placement infections in pa-tients with acute leukemia were analyzed by receiver operating characteristic curve(ROC)analysis.RESULTS A total of 34 strains were isolated from 26 acute leukemia patients with PICC infection,including 23 strains of gram-negative bacteria(67.65%),10 strains of gram-positive bacteria(29.41%),one strain of fungus(2.94%).The levels of serum PCT,ET,peripheral blood NLR and plasma TM in the infection group were higher than those in the non-infection group(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of combined detection of serum PCT,ET,NLR and TM was 0.931,which was higher than that of single detection(P<0.05).CONCLUSION The pathogenic bacteria of PICC catheterization infection in patients with acute leukemia were mainly gram-negative bacteria,and different pathogens have different characteristics of drug-resistance to an-tibiotics.

关 键 词：急性白血病 经外周静脉置入中心静脉导管 感染 病原菌 药敏结果 降钙素原 内毒素 中性粒细胞/淋巴细胞数比值 血栓调节蛋白 

分 类 号：R733.71[医药卫生—肿瘤]