胰十二指肠切除术后腹腔感染病原菌分布及炎症指标的诊断价值  

Distribution of pathogens isolated from pancreaticoduodenectomy patients with postoperative intra-abdominal infection and diagnostic values of inflammatory indexes

作　　者：罗亮 陈汇 吴宸 周航宇 明锐 周宁 LUO Liang;CHEN Hui;WU Chen;ZHOU Hang-yu;MING Rui;ZHOU Ning(Mianyang 404 Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳四〇四医院普外科,四川绵阳621000 [2]绵阳四〇四医院病理科,四川绵阳621000

出　　处：《中华医院感染学杂志》2025年第2期230-234,共5页Chinese Journal of Nosocomiology

基　　金：四川省卫生健康委医学科研计划项目(S16015)。

摘　　要：目的探究胰十二指肠切除术后腹腔感染患者病原菌分布及C-反应蛋白(CRP)/白蛋白(ALB)、降钙素原(PCT)、白细胞计数(WBC)、基质金属蛋白酶9(MMP-9)的诊断价值,期望为临床及早防治提供支持。方法选取2019年3月—2023年12月绵阳四〇四医院收治的胰十二指肠切除术后腹腔感染患者57例为感染组,另随机选取术后无腹腔感染患者65例为非感染组,统计感染病原菌分布,受试者工.作特征(ROC)曲线分析CRP/ALB、PCT、WBC、MMP-9对胰十二指肠切除术后腹腔感染的诊断价值。结果感染组与非感染组患者CRP/ALB、PCT、WBC、MMP-9水平比较差异有统计学意义(P<0.05),感染组患者四指标水平均升高,分别为(1.49±0.43)、(0.71±0.23)ng/ml、(15.27±4.58)×10^(9)/L、(114.70±34.92)ng/ml;57例感染患者检出71株病原菌,革兰阴性菌43株占60.56%,以铜绿假单胞菌居多;革兰阳性菌25株占35.21%,以肠球菌居多;真菌3株占4.23%。CRP/ALB、PCT、WBC、MMP-9联合检测诊断胰十二指肠切除术后腹腔感染的曲线下面积(AUC)值为0.942,敏感度、特异度为82.46%、95.38%。结论革兰阴性菌是胰十二指肠切除术后腹腔感染的主要病原菌,感染患者CRP/ALB、PCT、WBC、MMP-9水平呈高表达,四指标联合检测可提高感染的诊断价值。OBJECTIVE To explore the distribution of pathogens isolated from the pancreaticoduodenectomy patients with postoperative intra-abdominal infection and analyze the diagnostic values of C-reactive protein(CRP)/albumin(ALB),procalcitonin(PCT),white blood cell(WBC)and matrix metalloproteinase-9(MMP-9)so as to provide guidance for early prevention and treatment.METHODS A total of 57 patients who underwent the pancreaticoduodenectomy and had postoperative intra-abdominal infection in Mianyang 404 Hospital from Mar.2019 to Dec.2023 were assigned as the infection group,meanwhile,65 patients who did not have postoperative intra-abdominal infection were chosen as the non-infection group.The distribution of the pathogens isolated from the patients with the infection was statistically analyzed.The values of CRP/ALB,PCT,WBC and MMP-9 in diagnosis of the postoperative intra-abdominal infection were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS There were significant differences in the levels of CRP/ALB,PCT,WBC and MMP-9 between the infection group and the non-infection group(P<0.05).The levels of the four indexes of the infection group were(1.49±0.43),(0.71±0.23)ng/ml,(15.27±4.58)×10^(9)/L and(114.70±34.92)ng/ml,respectively,which were all elevated.Totally 71 strains of pathogens were isolated from the 57 patients with the infection,43(60.56%)of which were gram-negative bacteria,25(35.21%)were gram-positive bacteria,and 3(4.23%)were fungi;Pseudomonas aeruginosa was the predominant species of the gram-negative bacteria,and Enterococcus was dominant among the gram-positive bacteria.The area under the curve(AUC)of the joint detection of CRP/ALB,PCT,WBC and MMP-9 was 0.942 in diagnosis of the postoperative intra-abdominal infection in the pancreaticoduodenectomy patients,with the sensitivity 82.46%,the specificity 95.38%.CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the pancreaticoduodenectomy patients with postoperative intra-abdominal infection.The patients

关 键 词：胰十二指肠 腹腔感染 病原菌 基质金属蛋白酶9 C-反应蛋白 白蛋白 降钙素原 白细胞计数 受试者工作特征曲线 诊断价值 

分 类 号：R619.3[医药卫生—外科学]