老年类风湿性关节炎合并感染的病原菌及ESR、HBP和TNF-α的诊断价值  

Pathogens isolated from elderly rheumatoid arthritis patients complicated with infection and diagnostic values of ESR,HBP and TNF-α

作　　者：成强 李璟佳 王海兵 张瑶 李华[2] CHENG Qiang;LI Jing-jia;WANG Hai-bing;ZHANG Yao;LI Hua(Chinese People's Liberation Army Nay 971 Hospital,Qingdao,Shandong 266000,China;不详)

机构地区：[1]中国人民解放军海军第九七一医院保健科,山东青岛266000 [2]青岛大学附属医院风湿免疫科,山东青岛266555

出　　处：《中华医院感染学杂志》2025年第2期193-197,共5页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展基金资助项目(2020WS069);青岛市卫生医药科研指导计划面上项目(2023-WJZD239)。

摘　　要：目的探讨老年类风湿性关节炎(RA)合并感染的病原菌及红细胞沉降率(ESR)、肝素结合蛋白(HBP)、肿瘤坏死因子-α(TNF-α)联合的诊断价值,为临床的诊疗提供指导。方法随机选取2020年10月—2023年10月中国人民解放军海军第九七一医院和青岛大学附属医院收治的82例老年RA合并感染患者为感染组,91例老年RA未合并感染患者为未感染组;统计感染患者感染部位、检出病原菌及其药敏结果,比较两组患者外周血ESR、HBP、TNF-α水平,采用受试者工作特征(ROC)曲线分析三指标对老年RA患者合并感染的诊断价值。结果老年RA合并感染部位主要为呼吸系统(34.15%)及泌尿系统(23.17%)。82例老年RA合并感染患者共培养出98株病原菌,主要为大肠埃希菌、金黄色葡萄球菌。大肠埃希菌对氨苄西林、头孢唑林、哌拉西林耐药严重,金黄色葡萄球菌对青霉素耐药严重。感染组ESR(35.92±9.87)mm/h、HBP(50.41±16.21)ng/ml、TNF-α(80.05±26.67)ng/L高于未感染组(P<0.05)。ESR、HBP、TNF-α联合诊断老年RA患者合并感染的曲线下面积(AUC)值为0.948,敏感度为91.46%,特异度为97.80%。结论老年RA合并感染患者以呼吸系统、泌尿系统感染为主,病原菌主要为大肠埃希菌、金黄色葡萄球菌,各病原菌耐药性有一定差异,ESR、HBP、TNF-α水平升高,三者联合诊断感染的价值较高。OBJECTIVE To explore the pathogens isolated from the elderly rheumatoid arthritis(RA)patients complicated with infection and analyze the diagnostic value of joint detection of erythrocyte sedimentation rate(ESR),heparin-binding protein(HBP)and tumor necrosis factor-α(TNF-α)so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 82 elderly RA patients complicated with infection who were treated in Chinese People′s Liberation Army Navy 971 Hospital and Qingdao University Affiliated Hospital from Oct.2020 to Oct.2023 were randomly chosen as the research subjects and were assigned as the infection group,and 91 elderly RA patients who were not complicated with infection were assigned as the no infection group.The infection sites,isolated pathogens and result of drug susceptibility testing were statistically analyzed,the levels of peripheral blood ESR,HBP and TNF-α were compared between the two groups of patients,and the values of the three indexes in diagnosis of the infection in the elderly RA patients were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Respiratory system(34.15%)and urinary system(23.17%)were the major infection sites of the elderly RA patients complicated with infection.Totally 98 strains of pathogens were isolated from the 82 elderly RA patients complicated with infection,among which Escherichia coli and Staphylococcus aureus were dominant.The E.coli strains were most resistant to ampicillin,cefazolin and piperacillin;the S.aureus strains were highly resistant to penicillin.The ESR,HBP and TNF-αof the infection group were respectively(35.92±9.87)mm/h,(50.41±16.21)ng/ml and(80.05±26.67)ng/L,significantly higher than those of the no infection group(P<0.05).The area under the curve(AUC)of the joint detection of ESR,HBP and TNF-α was 0.948 in diagnosis of the infection in the elderly RA patients,with the sensitivity 91.46%,the specificity 97.80%.CONCLUSIONS The patients with respiratory system infection and urinary system infection are domi

关 键 词：类风湿性关节炎 感染 病原菌分布 耐药 红细胞沉降率 肝素结合蛋白 肿瘤坏死因子-α 

分 类 号：R684.3[医药卫生—骨科学]