冠心病合并肺部感染患者病原菌分布及血清MIP-2、CD40L水平的诊断价值  

The Distribution of Pathogenic Bacteria and the Diagnostic Value of Serum MIP-2 and CD40L Levels in Patients with Coronary Heart Disease Complicated with Pulmonary Infection

作　　者：翟金金 张保振 汪薇 田巍 ZHAI Jinjin;ZHANG Baozhen;WANG Wei;TIAN Wei(Cadre Section,Beijing Jishuitan Hospital of Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院干部科,北京100035

出　　处：《转化医学杂志》2024年第5期665-669,共5页Translational Medicine Journal

基　　金：国家重点研发计划项目(编号:2020YFC2005403)。

摘　　要：目的探究冠心病合并肺部感染患者病原菌分布及血清巨噬细胞炎性蛋白-2(MIP-2)、CD40配体(CD40L)水平的诊断价值。方法选择2022年11月至2024年2月首都医科大学附属北京积水潭医院诊治的冠心病合并肺部感染患者93例(研究组)与未合并肺部感染的冠心病患者93例(对照组)进行研究。检测研究组病原菌分布情况,比较2组患者一般资料,Pearson分析血清MIP-2、CD40L与冠心病合并肺部感染的相关性,Logistics回归分析冠心病合并肺部感染的影响因素,受试者工作特征(ROC)曲线分析血清MIP-2、CD40L水平对冠心病合并肺部感染的诊断价值。结果研究组经病原菌培养分离得到革兰阴性菌61株(59.80%),革兰阳性菌33株(32.35%),真菌8株(7.85%);研究组与对照组心功能分级、左室射血分数(LVEF)、C反应蛋白(CPR)、降钙素原(PCT)、N末端B型脑钠肽前体(NT-proBNP)、MIP-2、CD40L比较差异均有统计学意义(P<0.05)。血清MIP-2、CD40L与冠心病合并肺部感染呈正相关(r=0.362、P=0.000);MIP-2、CD40L升高是冠心病患者合并肺部感染的危险因素(P<0.05)。血清MIP-2、CD40L、两者联合诊断冠心病合并肺部感染的曲线下面积(AUC)分别为0.812(95%CI:0.750~0.874)、0.793(95%CI:0.729~0.856)、0.869(95%CI:0.817~0.921),两者联合对冠心病合并肺部感染的诊断价值高于单独诊断(ggd两者联合-MIP-2=2.191、P=0.028,Z两者联合-CD40L=2.838、P=0.005)。结论冠心病合并肺部感染患者以革兰阴性菌感染为主,患者血清MIP-2、CD40L水平升高,血清MIP-2、CD40L升高增加冠心病患者合并肺部感染的风险,两者联合对冠心病患者合并肺部感染具有一定诊断意义。Objective To investigate the distribution of pathogenic bacteria and the diagnostic value of serum macrophage inflammatory protein-2(MIP-2)and CD40 ligand(CD40L)levels in patients with coronary heart disease complicated with pulmonary infection.Methods A total of 93 patients with coronary heart disease complicated with pulmonary infection treated in our hospital from November 2022 to February 2024(study group)and 93 patients with coronary heart disease without pulmonary infection(control group)were selected for the study.Pearson analysis was applied to analyze the correlation between serum MIP-2 and CD40L in the study group.Logistic regression analysis was used to analyze the influencing factors of pulmonary infection in patients with coronary heart disease.ROC curve analysis was performed to evaluate the diagnostic value of serum MIP-2 and CD40L levels in patients with coronary heart disease complicated by pulmonary infection.Results 61 strains(59.80%)of Gram-negative bacteria,33 strains(32.35%)of Gram-positive bacteria,and 8 strains(7.85%)of fungi were isolated through pathogen cultivation.There were statistically significant differences in cardiac function grading,LVEF,CPR,PCT,NT-proBNP,MIP-2,and CD40L between the study group and the control group(P<0.05).Serum MIP-2 and CD40L levels in the study group were positively correlated(r=0.362,P=0.000).MIP-2 and CD40L were independent risk factors for pulmonary infection in patients with coronary heart disease(P<0.05).The AUC of serum MIP-2,CD40L,and their combination in diagnosing coronary heart disease with pulmonary infection was 0.812(95%CI=0.750-0.874),0.793(95%CI=0.729-0.856),and 0.869(95%CI=0.817-0.921),respectively.The diagnostic value of their combination was significantly higher than individual diagnosis(Z combination-MIP-2=2.191,P=0.028,Z combination-CD40L=2.838,P=0.005).Conclusion Patients with coronary heart disease complicated with pulmonary infection are primarily infected with Klebsiella pneumoniae.Elevated levels of serum MIP-2 and CD40L increase the

关 键 词：冠心病 肺部感染 病原菌分布 巨噬细胞炎性蛋白-2 CD40配体 诊断价值 

分 类 号：R541.4[医药卫生—心血管疾病] R563.119[医药卫生—内科学]