老年胆总管结石继发急性重症胆管炎的病原菌构成、耐药性及驱动因素  

The pathogen composition,drug resistance,and driving factors in acute severe cholangitis secondary to elderly common bile duct stones

作　　者：张靖宇 马路平 尹世航 刘星 ZHANG Jing-yu;MA Lu-ping;YIN Shi-hang;LIU Xing(Department of General Surgery,Zhangjiakou First Hospital,Zhangjiakou 075000,Hebei,China)

机构地区：[1]张家口市第一医院普外科,河北张家口075000

出　　处：《川北医学院学报》2024年第10期1415-1419,共5页Journal of North Sichuan Medical College

摘　　要：目的:探讨老年胆总管结石继发急性重症胆管炎(ACST)的病原菌构成、耐药性及驱动因素,并构建相关预测模型,探索其预测价值。方法:回顾性分析186例老年胆总管结石患者的临床资料,根据是否继发ACST分为胆总管结石继发ACST组(n=87)和胆总管结石组(n=99)。分析老年胆总管结石继发ACST的病原菌构成及耐药性,比较两组临床资料,利用向后逐步Logistic回归分析老年胆总管结石继发ACST的驱动因素,并将胆总管结石继发ACST组纳入阳性,胆总管结石组纳入阴性,采用MedCalc 11.4绘制受试者工作特征(ROC)曲线分析预测模型对老年胆总管结石继发ACST的预测价值。结果:87例老年胆总管结石继发ACST患者检出病原菌以革兰阴性菌最多,为69株。革兰阴性菌中大肠埃希菌检出最多,为28株,其耐药率较高的药物包括氨苄西林、左氧氟沙星、磺胺甲噁唑/甲氧苄啶、环丙沙星。向后逐步Logistic回归分析结果显示,年龄>70岁、有吸烟史、有胆道手术史、有胆管扩张、有结石嵌顿是老年胆总管结石继发ACST的驱动因素(P<0.05)。建立预测模型:logit(P)=-10.515+年龄×0.714+有吸烟史×0.693+有胆道手术史×0.674+有胆管扩张×0.819+有结石嵌顿×1.023。ROC特征曲线分析结果显示,当logit(P)>9.61时,曲线下面积(AUC)为0.889,95%CI为0.835~0.930,敏感度为78.16%,特异度为82.63%。结论:革兰阴性菌为老年胆总管结石继发ACST患者主要致病菌,不同病原菌的耐药特点各异,且年龄>70岁、有吸烟史、有胆道手术史、有胆管扩张、有结石嵌顿为老年胆总管结石患者继发ACST的驱动因素,据此建立的预测模型有较好的预测价值。Objective:To investigate the pathogen composition,drug resistance,and driving factors in acute severe cholangitis(ACST)secondary to elderly common bile duct stones,and construct relevant predictive models to explore their predictive value.Methods:A retrospective analysis was conducted on the clinical data of 186 elderly patients with common bile duct stones,they were divided into the choledocholithiasis secondary ACST group(n=87)and the choledocholithiasis group(n=99)according to whether the selected patients had secondary ACST.The pathogen composition and drug resistance of ACST secondary to elderly common bile duct stones were analyzed,the clinical data of two groups were compared,the driving factors of ACST secondary to elderly common bile duct stones were analyzed by backward stepwise Logistic regression,and include the group of ACST secondary to choledocholithiasis as positive,and the group of ACST secondary to choledocholithiasis as negative,the predictive value of the predictive model for ACST secondary to elderly common bile duct stones were analyzed by use MedCalc 11.4 to draw receiver operating characteristic curves(ROC).Results:Pathogenic bacteria detected in 87 elderly patients with choledocholithiasis secondary to ACST were most frequently detected by gram-negative bacteria with 69 strains.Among the gram-negative bacteria,Escherichia coli was detected most frequently with 28 strains,and the drugs with high resistance rates included ampicillin,levofloxacin,sulfamethoxazole/metronidazole,and ciprofloxacin.The results of backward stepwise Logistic regression analysis showed that age>70 years old,smoking history,history of biliary surgery,bile duct dilation and stone entrapmen were the driving factors for ACST secondary to elderly common bile duct stones(P<0.05).Establish a predictive model:logit(P)=-10.515+age×0.714+smoking history×0.693+history of biliary surgery×0.674+presence of bile duct dilation×0.819+presence of stone entrapment×1.023.The ROC characteristic curve analysis results showed that

关 键 词：胆总管结石 老年 急性重症胆管炎 病原菌 耐药性 驱动因素 

分 类 号：R378[医药卫生—病原生物学]