老年慢性支气管炎合并肺部感染病原菌及血清IL-6水平对临床转归的影响  

Pathogens isolated from elderly chronic bronchitis patients complicated with pulmonary infection and impact of serum IL-6 on clinical outcomes

作　　者：金斌 顾娟仙 叶书佳 李晓霞 李琳 赵春辉 JIN Bin;GU Juan-xian;YE Shu-jia;LI Xiao-xia;LI Lin;ZHAO Chun-hui(Haining People's Hospital,Jiaring,Zhejiang 314400,China)

机构地区：[1]海宁市人民医院重症医学科,浙江嘉兴314400 [2]海宁市人民医院呼吸内科,浙江嘉兴314400

出　　处：《中华医院感染学杂志》2024年第21期3211-3215,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2022505672)。

摘　　要：目的探讨老年慢性支气管炎合并肺部感染病原菌及血清白细胞介素-6(IL-6)水平对临床转归的影响。方法回顾性分析2020年1月-2023年12月海宁市人民医院收治的140例老年慢性支气管炎合并肺部感染患者临床资料,进行病原菌鉴定,根据患者住院期间死亡情况,分为生存组(n=116)与死亡组(n=24),对比两组感染发生时血清IL-6水平及肺功能[用力肺活量(FVC)、1秒钟用力呼气量(FEV1)、FEV1/FVC]差异,通过受试者工作特征(ROC)曲线评估血清IL-6对患者预后的预测价值。结果140例患者包括单一菌种感染94例,占67.14%;多个菌种感染患者46例,占32.86%;分离出的190株病原菌中,以革兰阴性菌占比最高为52.63%;死亡组患者感染发生后血清IL-6水平高于生存组(P<0.05);死亡组感染发生后FVC、FEV1、FEV1/FVC水平低于生存组(P<0.05);血清IL-6水平评估患者不良预后ROC曲线下面积0.929,灵敏度91.67%、特异度85.34%。结论老年慢性支气管炎合并肺部感染患者以革兰阴性菌感染占比较高,部分患者可合并多个菌种感染,患者血清IL-6水平高表达状态可在一定程度上预示患者不良预后。OBJECTIVE To explore the pathogens isolated from the elderly chronic bronchitis patients complicated with pulmonary infection and observe the impact of serum interleukin-6(IL-6)on clinical outcomes.METHODS A total of 140 elderly chronic bronchitis patients who were complicated with pulmonary infection and treated in Haining People′s Hospital from Jan.2020 to Dec.2023 were enrolled in the study and were divided into the survival group with 116 cases and the death group with 24 cases according to survival status during the hospital stay.The clinical data of the enrolled patients were retrospectively analyzed,the pathogens were identified.The serum IL-6 level and lung function indexes[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC]were observed and compared between the two groups of patients when the infection occurred.The value of serum IL-6 in prediction of prognosis was evaluated by means of receiver operating characteristic(ROC)curves.RESULTS Of the 140 patients,94(67.14%)had the infection of single species,and 46(32.86%)had the infections of multiple species.Totally 190 strains of pathogens were isolated,52.63%of which were gram-negative bacteria.The serum IL-6 level of the death group was significantly higher than that of the survival group after the infection occurred(P<0.05);the FVC,FEV1 and FEV1/FVC of the death group were lower than those of the survival group(P<0.05).The area under the ROC curve of the serum IL-6 was 0.929 in assessment of poor prognosis,with the sensitivity 91.67%,the specificity 85.34%.CONCLUSIONS The patients with gram-negative bacteria infections are dominant among the elderly chronic bronchitis patients complicated with pulmonary infection,some patients may be complicated with infections of multiple species.The high expression level of serum IL-6 may indicate the poor prognosis of the patients.

关 键 词：慢性支气管炎 肺部感染 老年 病原学 白细胞介素-6 

分 类 号：R562.21[医药卫生—呼吸系统]