乳腺癌患者PICC相关血流感染病原菌及其CGRP、PD-1/PD-L1水平  

Pathogenic bacteria for PICC associated bloodstream infectionsin breast cancer patients and their CGRP and PD-1/PD-L1 levels

作　　者：宋睿 谢海燕 马一鸣 夏菊玲 浩育盈 SONG Rui;XIE Haiyan;MA Yiming;XIA Juling;HAO Yuying(Affiliated Hospital of Shaanri University of Traditional Chinese Medicine,Xianyang,Shaanxi 712000,China;不详)

机构地区：[1]陕西中医药大学附属医院护理部,陕西咸阳712000 [2]陕西中医药大学附属医院肿瘤医院五病区,陕西咸阳712000 [3]陕西省肿瘤医院中西医结合科,陕西西安710061

出　　处：《中华医院感染学杂志》2025年第4期528-532,共5页Chinese Journal of Nosocomiology

基　　金：陕西省自然科学基础研究计划基金资助项目(2022JM-448);中华中医药学会护理专业发展基金资助项目(HLKT-CACM-2022-1-10);咸阳市科技局基金资助项目(L2023-ZDYF-SF-040);陕西中医药大学校级科研基金资助项目(2023GP21)。

摘　　要：目的 探讨乳腺癌患者经外周静脉置入中心静脉导管(PICC)相关血流感染(CRBSI)病原菌及其药敏结果,并分析降钙素基因相关肽(CGRP)、细胞程序性死亡受体-1(PD-1)/细胞程序性死亡受体-配体1(PD-L1)对其预测价值。方法 选取陕西中医药大学附属医院2020年11月-2023年12月收治的乳腺癌并行PICC患者213例,根据CRBSI情况分为感染组(52例)和未感染组(161例)。统计感染组病原菌及其药敏结果;比较两组CGRP、PD-1、PD-L1、PD-1/PD-L1水平,采用受试者工作特征(ROC)曲线分析各指标对乳腺癌并行PICC患者CRBSI预测价值。结果 52例乳腺癌并行PICC发生CRBSI患者共检出病原菌69株,其中革兰阴性菌42株占60.87%,革兰阳性菌27株占39.13%,以大肠埃希菌和表皮葡萄球菌为主。大肠埃希菌对阿莫西林、头孢唑林完全耐药,未检出对美罗培南耐药菌株;表皮葡萄球菌对红霉素、青霉素耐药率>90%,未检出对呋喃妥因、利奈唑胺、万古霉素耐药的菌株。感染组PD-1、PD-1/PD-L1分别为(2.61±0.79)、(2.07±0.65)高于未感染组,CGRP、PD-L1分别为(36.36±11.25) pg/ml、(1.21±0.37)低于未感染组(P<0.05)。CGRP、PD-1、PD-L1、PD-1/PD-L1四者联合检测曲线下面积(AUC)高于单独检测(P<0.05),且联合检测的敏感度、特异度为80.77%、88.82%。结论 革兰阴性菌为乳腺癌并行PICC患者发生CRBSI的主要病原菌,乳腺癌行PICC发生CRBSI患者外周血CGRP、PD-1、PD-L1、PD-1/PD-L1表达异常,且四者联合检测可提高诊断价值。OBJECTIVE To investigate the pathogenic bacteria of catheter-related bloodstream infection(CRBSI)in breast cancer patients with peripherally inserted central catheter(PICC)and their drug sensitivity results,and to analyze the predictive value of calcitonin gene-related peptide(CGRP),and programmed cell death-1(PD-1)/pro-grammed cell death-ligand 1(PD-L1).METHODS Totally 213 breast cancer patients with PICC admitted to Affili-ated Hospital of Shaanxi University of Traditional Chinese Medicine from Nov.2020 to Dec.2023 were selected and divided into the infection group(52 cases)and the non-infection group(161 cases)according to the situation of CRBSI.The pathogenic bacteria and drug sensitivity results in the infection group were counted.The levels of CGRP,PD-1,PD-L1 and PD-1/PD-L1 were compared between the two groups,and receiver operating character-istic curve(ROC)was used to analyze the predictive value of each index for CRBSI in breast cancer patients with PICC.RESULTS A total of 69 strains of pathogenic bacteria were detected in 52 breast cancer patients with PICC CRBSI,of which 42 strains of gram-negative bacteria accounted for 60.87%,27 strains of gram-positive bacteria accounted for 39.13%,mainly Escherichia coli and Staphylococcus epidermidis.Escherichia coli was completely resistant to amoxicillin and cefazolin,and no meropenem resistant strains were detected.The resistance rates of Staphylococcus epidermidis to erythromycin and penicillin were more than 9o%,and no strains were detected that were resistant to nitrofurantoin,linezolid or vancomycin.The levels of PD-1 and PD-1/PD-L1 in the infection group were(2.61±0.79)and(2.07±0.65),respectively,which were higher than those in the non-infection group,while the levels of CGRP and PD-L1 in the infection group were(36.36±11.25)pg/ml and(1.21±0.37),respectively,which were lower than those in the non-infection group(P<0.05).The area under the curve(AUC)of the combined detection of CGRP,PD-1,PD-L1 and PD-1/PD-L1 was higher than that of the individual detect

关 键 词：乳腺癌 经外周静脉置入中心静脉导管 导管相关血流感染 病原菌 药敏试验 降钙素基因相关肽 细胞程序性死亡受体-1 细胞程序性死亡受体-配体1 受试者工作特征曲线 预测价值 

分 类 号：R737.9[医药卫生—肿瘤]