sFlt-1、D-乳酸、LDH表达在急性重症胰腺炎合并感染临床诊断的价值研究  

Study on the clinical diagnostic value of sFlt-1,D-Lactate and LDH Expression in acute severe pancreatitis complicated with infection

作　　者：王誉翔 许明 陈钰 WANG Yuxiang;XU Ming;CHEN Yu(Department of Critical Care Medicine,Xinyang People's Hospital,Xinyang 464000,China;Department of Critical Care Medicine,Xinyang Central Hospital,Xinyang,464000,China)

机构地区：[1]信阳市人民医院重症医学科,河南信阳464000 [2]信阳市中心医院重症医学科,河南信阳464000

出　　处：《黑龙江医药科学》2025年第1期114-117,共4页Heilongjiang Medicine and Pharmacy

摘　　要：目的:探讨急性重症胰腺炎(SAP)合并感染患者可溶性血管内皮生长因子受体-1(sFlt-1)、D-乳酸、乳酸脱氢酶(LDH)表达在该合并症中的临床诊断价值及菌群分布与耐药性。方法:选取2021年12月至2023年11月信阳市人民医院急诊科收治的SAP患者80例进行回顾分析,根据SAP是否合并感染分组,分成A组(SAP)、B组(SAP合并感染),判断急性重症胰腺炎合并感染患者sFlt-1、D-乳酸、LDH表达在临床诊断的价值研究及菌群分布与耐药性。结果:(1)A、B组的BMI、HDL-C、LDL-C、FBG、BUN、TC、TG及hs-CRP、D-二聚体等指标表达水平相比无显著差异(P>0.05)。(2)A组的sFlt-1、D-乳酸、LDH表达水平较B组更低,差异显著(P<0.05)。(3)单项诊断时,sFlt-1、D-乳酸、LDH的AUC值各0.876、0.765、0.812,SEN各82.43%、83.05%和83.45%,SPE各79.54%、76.43%、80.00%,而3种联合诊断时的AUC、SEN、SPE各0.937、91.44%和91.23%。(4)80例SAP合并感染患者合计分离出201株菌株,葡萄球菌、链球菌、肺炎球菌、淋球菌、脑膜炎球菌及其他各占27.86%、19.40%、20.40%、14.43%、10.45%和7.46%,其中血压或中心静脉导管、坏死组织、腹部脓液、腹腔引流及胆汁各占17.41%、27.86%、17.91%、24.38%、12.44%。(5)5-氟胞嘧啶、两性霉素B、伊曲康唑、氟康唑及伏立康唑等5类药物在葡萄球菌、链球菌、肺炎球菌、淋球菌、脑膜炎球菌及其他菌种中合计占比各82.59%、90.55%、54.73%、76.62%、98.51%。结论:在SAP合并感染患者的早期诊断中sFlt-1、D-乳酸、LDH联合诊断的价值更高,临床应用价值较好。同时SAP合并感染患者在临床治疗时的菌群分布及对相关药物的耐药性各异。Objective:To investigate the clinical diagnostic value of soluble fms-like tyrosine kinase-1(sFlt-1),D-lactate,and lactate dehydrogenase(LDH)expression in patients with acute severe pancreatitis(SAP)complicated with infection,as well as the bacterial flora distribution and drug resistance.Methods:A retrospective analysis was conducted on 80 SAP patients admitted to the emergency department of Xinyang People's Hospital from December 2021 to November 2023.Patients were divided into two groups based on whether SAP was complicated with infection:Group A(SAP only)and Group B(SAP with infection).The clinical diagnostic value of sFlt-1,D-lactate and LDH expression,as well as the bacterial flora distribution and drug resistance,were evaluated in patients with SAP complicated with infection.Results:(1)There were no significant differences in BMI,HDL-C,LDL-C,FBG,BUN,TC,TG,hs-CRP and D-dimer levels between Groups A and B(P>0.05).(2)The expression levels of sFlt-1,D-lactate and LDH were significantly lower in Group A compared to Group B(P<0.05).(3)For individual test,the AUC values of sFlt-1,D-lactate and LDH were 0.876,0.765,and 0.812,respectively.The sensitivity(SEN)was 82.43%,83.05%and 83.45%,and the specificity(SPE)was 79.54%,76.43%,and 80.00%,respectively.When the three markers were used in combination for diagnosis,the the AUC SEN,and SPE reached 0.937,91.44%,and 91.23%,respectively.The isolation rates from blood or central venous catheter,necrotic tissue,abdominal pus,peritoneal drainage,and bile were 17.41%,27.86%,17.91%,24.38%,and 12.44%respectively.(4)A total of 201 bacterial strains were isolated from 80 SAP patients with infection,including Staphylococcus 27.86%,Streptococcus 19.40%,Pneumococcus 20.40%,Gonococcus 14.43%,Meningococcus 10.45%,and others 7.46%.The main sources of infection were blood pressure or central venous catheters 17.41%,necrotic tissue 27.86%,abdominal pus 17.91%,peritoneal drainage 24.38%,and bile 12.44%.(5)The overall resistance rates of five antifungal drugs(5-fluorocytosine,amphotericin B

关 键 词：急性重症胰腺炎 SFLT-1 D-乳酸 LDH 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]