脑外伤患者肺部感染病原菌耐药性与sTREM-1、CRPALB、TFPI-1、PA、D-D水平及其预测价值  

Pathogenic bacterial resistance in patients with traumatic brain injury combined with pulmonary infection and sTREM-1,CRPALB,TFPI-1,PA and D-D levels and their predictive value

作　　者：王黄锁 周杰 唐霍全 李波 任星光 胡静静 芦戬[1] WANG Huangsuo;ZHOU Jie;TANG Huoquan;LI Bo;REN Xingguang;HU Jingjing;LU Jian(Taiyuan Iron and Steel(Group)Co.,Ltd.General Hospital,Taiyuan,Shanri 030008,China)

机构地区：[1]太原钢铁(集团)有限公司总医院神经外科,山西太原030008

出　　处：《中华医院感染学杂志》2025年第3期384-389,共6页Chinese Journal of Nosocomiology

基　　金：山西省卫健委基金资助项目(2021035)。

摘　　要：目的探讨脑外伤患者肺部感染病原菌耐药性与血清可溶性髓系细胞触发受体-1(sTREM-1)、C-反应蛋白与白蛋白比值(CRP/ALB)、组织因子途径抑制物-1(TFPI-1)、前白蛋白(PA)、D-二聚体(D-D)水平及其预测价值。方法选取2022年1月—2023年10月太原钢铁(集团)有限公司总医院收治的101例脑外伤肺部感染患者作为感染组,另选取同期医院收治的115例脑外伤未发生肺部感染患者作为未感染组。分析脑外伤患者肺部感染病原菌耐药性,比较两组sTREM-1、CRP/ALB、TFPI-1、PA、D-D水平。绘制受试者工作特征(ROC)曲线分析血清sTREM-1、CRP/ALB、TFPI-1、外周血PA、D-D对脑外伤患者肺部感染的预测价值。结果101例脑外伤肺部感染患者共检出菌株112株,其中革兰阴性菌67株(59.82%),革兰阳性菌36株(32.14%),真菌9株(8.04%),以铜绿假单胞菌、肺炎克雷伯菌和金黄色葡萄球菌为主。感染组sTREM-1、CRP/ALB、TFPI-1、D-D分别为(36.73±9.85)pg/ml、(4.02±1.25)、(42.31±9.75)μg/L、(9.72±3.14)mg/L高于未感染组(P<0.05),气管切开时间为(19.34±2.24)d长于未感染组(P<0.05),PA为(162.76±38.32)mg/L低于未感染组(P<0.05)。sTREM-1、CRP/ALB、TFPI-1、PA、D-D联合检测预测脑外伤患者发生肺部感染的曲线下面积(AUC)值为0.943高于五者单一检测。结论革兰阴性菌为脑外伤肺部感染患者主要致病菌,不同致病菌的耐药特点各异,sTREM-1、CRP/ALB、TFPI-1、D-D在脑外伤肺部感染患者呈高表达,而PA呈低表达,五者联合检测预测脑外伤患者发生肺部感染的价值更高。OBJECTIVE To investigate the resistance of pathogenic bacteria in patients with traumatic brain injury combined with pulmonary infection and serum soluble myeloid triggering receptor-1(sTREM-1),C-reactive protein to albumin ratio(CRP/ALB),tissue factor pathway inhibitor-1(TFPI-1),peripheral blood prealbumin(PA),and D-dimer(D-D)levels and their predictive values.METHODS One hundred and one patients with traumatic brain injury combined with pulmonary infection admitted to Taiyuan Iron and Steel(Group)Co.general hospital from Jan.2022 to Oct,2023 were selected as the infected group,and 115 patients with traumatic brain injury without pulmonary infection admitted to the hospital during the same period were selected as the uninfected group.Pathogenic bacteria resistance was analyzed,and sTREM-1,CRP/ALB,TFPI-1,PA,and D-D levels were compared between the two groups.The predictive values of serum sTREM-1,CRP/ALB,TFPI-1,peripheral blood PA,and D-D for pulmonary infections in patients with traumatic brain injury was analyzed by the receiver operating characteristics(ROC)curve.RESULTS A total of 112 strains of pathogenic bacteria were detected in 101 patients with traumatic brain injury combined with lung infections,including 67 strains of gram-negative(59.82%),36 strains of gram-positive(32.14%),and 9 strains of fungal strains(8.04%),with Pseudomonas aeruginosa,Klebsiella pneumoniae,and Staphylococcus aureus predominantly.The levels of sTREM-1,CRP/ALB,TFPI-1,and D-Din the infected group were(36.73±9.85)pg/ml,(4.02±1.25),(42.31±9.75)μg/L,and(9.72±3.14)mg/L,respectively,higher than those in the uninfected group(P<0.05).Tracheotomy time was(19.34±2.24)d,longer than that of the uninfected group(P<0.05),and peripheral blood PA was(162.76±38.32)mg/L,lower than that of the uninfected group(P<0.05).The area under the curve(AUC)value of the combined detection of sTREM-1,CRP/ALB,TFPI-1,PA,and D-D for the prediction of pulmonary infections in traumatic brain injury patients was O.943,higher than that of single detection.CONCLU

关 键 词：脑外伤 肺部感染 病原菌 耐药性 可溶性髓系细胞触发受体-1 C-反应蛋白与白蛋白比值 组织因子途径抑制物-1 前白蛋白 D-二聚体 预测价值 

分 类 号：R563.1[医药卫生—呼吸系统]