血培养阳性患者革兰阳性菌与革兰阴性菌感染炎性标志物的差异  

Differences in inflammatory markers between gram⁃positive and gram⁃negative bacterial infections in patients with positive blood cultures

作　　者：王敏 金文平 禹红[2] 柯玲玲 祝金波 孙建斌 刘星[2] WANG Min;JIN Wenping;YU Hong;KE Lingling;ZHU Jinbo;SUN Jianbin;LIU Xing(Laboratory of Wuhan Third Hospital,Wuhan,Hubei 430060,China;Laboratory of Wuhan Traditional Chinese Medicine Hospital,Wuhan,Hubei 430060,China)

机构地区：[1]武汉市第三医院检验科,湖北武汉430060 [2]武汉市中医医院检验科,湖北武汉430060

出　　处：《热带医学杂志》2025年第1期94-98,共5页Journal of Tropical Medicine

基　　金：湖北省中医药管理局(ZY2023F052)。

摘　　要：目的探究烧伤科血培养阳性患者革兰阳性菌与革兰阴性菌感染炎性标志物的差异,为临床诊断和治疗提供参考。方法选择2018年1月-2022年12月武汉市第三医院烧伤科门诊及住院患者资料199例,根据患者病原菌革兰染色结果分为阳性组(n=90)和阴性组(n=109)。比较两组病原菌分布、中性粒细胞计数(NEU)、白细胞计数(WBC)、C-反应蛋白(CRP)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血肌酐(SCr)、降钙素原(PCT)水平。结果199例血培养阳性患者革兰阳性菌90例(45.23%),其中葡萄球菌属占比最高(24.12%);革兰阴性菌109例(54.77%),其中埃希菌属占比最高(21.11%)。阴性组患者入院24 h内、入院后3和7 d血清PCT、WBC水平均明显高于阳性组,差异均有统计学意义(t_(PCT)=27.880、26.249、56.466,t_(WBC)=9.763、6.662、5.472,P均<0.001)。两组入院24 h内CRP和NEU水平差异无统计学意义(P均>0.05),但入院后3和7 d阴性组上述两指标水平均明显高于阳性组,差异均有统计学意义(tCRP=9.267、55.705,tNEU=5.564、4.257,P均<0.001)。两组患者AST、ALT和SCr水平均随着时间增加而升高,差异均有统计学意义(P均<0.05)。阴性组PCT水平集中于≥2 ng/mL的区间内,阳性组集中于2~10 ng/mL区间内,差异有统计学意义(χ2=40.996,P<0.001)。结论血培养阳性患者多为葡萄球菌属和埃希菌属感染,革兰阴性感染者PCT、WBC和NEU水平均更高,其中PCT水平分布差异明显,可作为临床诊断和治疗的参考。Objective To investigate the differences between gram-positive and gram-negative bacterial infections and their inflammatory markers in blood culture-positive patients.Methods The data of 199 outpatients and inpatients in the burn unit of the Wuhan Third Hospital from January 2018 to December 2022 were selected,and the patients were divided into positive(n=90)and negative(n=109)groups according to their pathogenic bacteria gram staining results.The distribution of pathogenic bacteria,levels of neutrophil count(NEU),white blood cell(WBC),C-reactive protein(CRP),aspartate aminotransferase(AST),alanine aminotransferase(ALT),serum creatinine(SCr),procalcitonin(PCT)and their correlation between the two groups were analyzed.Results Ninety gram-positive bacteria(45.23%)were found in 199 positive blood culture patients,with the highest percentage of Staphylococcus spp.(24.12%),and 109 gram-negative bacteria(54.77%),with the highest percentage of Escherichia spp.(21.11%).Serum PCT and WBC levels within 24 h,3 d after admission and 7 d after admission were significantly higher in patients with gram-negative bacterial infections than in the positive group(t_(PCT)=27.880,26.249,56.466;t_(WBC)=9.763,6.662,5.472;all P<0.001).There was no significant difference in the levels of CRP and NEU between the two groups within 24 h of admission,but the levels of both of these indicators were significantly higher in the negative group than in the positive group 3 d after admission and 7 d after admission(tCRP=9.267,55.705;tNEU=5.564,4.257;all P<0.001).The levels of AST,ALT,and SCr in both groups of patients increased with increasing levels(all P<0.05).With PCT levels in the gram-negative group concentrated in the interval≥2 ng/mL and in the positive group concentrated in the interval from 2-10 ng/mL,and the differences were statistically significant(χ2=40.996,P<0.001).Conclusions Most of the positive blood culture patients in our burn unit were infected with Staphylococcus spp.and Escherichia spp.Gram-negative infections had higher l

关 键 词：血培养 革兰染色 降钙素原 

分 类 号：R446.5[医药卫生—诊断学]