2型糖尿病血流感染患者hs-CRP、PCT水平与感染类型的关系及对抗生素治疗指导价值  

The Relationship Between hs-CRP and PCT Levels and the Type of Infectionin Patients with Type 2 Diabetes Mellitus Bloodstream Infectionand Its Guiding Value for Antibiotic Treatment

作　　者：叶宁 杨大为 曹辉[1] 张引兰 YE Ning;YANG Dawei;CAO Hui;ZHANG Yinlan(Department of Pharmacy,The Second Hospital of Nanjing,Nanjing 210000,China)

机构地区：[1]南京市第二医院药学部,江苏南京210000

出　　处：《标记免疫分析与临床》2025年第2期341-348,共8页Labeled Immunoassays and Clinical Medicine

基　　金：基础研究计划自然科学基金-青年基金项目(编号:BK020230157)。

摘　　要：目的探究2型糖尿病(T2DM)血流感染(BSI)患者hs-CRP、PCT水平与感染类型的关系,以及为抗生素治疗提供指导。方法选取我院2020年1月至2022年11月确诊为T2DM-BSI的105例患者作为研究对象,根据患者所感染的病原微生物不同分为革兰阳性菌组(G+,n=28)、革兰阴性菌组(G-,n=68)和其他类型组(n=9)。对上述3组患者的一般临床资料和实验室指标进行统计分析,采用多因素Logistic回归模型和广义线性混合效应模型(GLMMs)分析hs-CRP、PCT水平与感染类型的关系。根据治疗过程中所用抗生素的疗效,将所有患者分为抗生素有效组(n=65)和无效组(n=40),结合联合模型,研究hs-CRP和PCT水平变化对抗生素治疗的指导价值。结果3组患者间的病程、hs-CRP、PCT、C-PR、HDL-C、IL-6和TNF-α比较存在显著差异,具有统计学意义(P<0.05);Logistic回归模型和GLMMs回归模型分析结果显示,hs-CRP和PCT为T2DM-BSI患者感染类型的独立危险因素,hs-CRP、PCT的水平越低,T2DM合并BSI患者感染类型为G+的概率越大(P<0.001);hs-CRP和PCT水平可以在治疗早期反映出抗生素的耐药性;联合模型显示,hs-CRP水平每上升1,抗生素耐药性的风险增加0.4%,PCT水平每上升1,抗生素耐药性的风险增加6%。结论hs-CRP和PCT可以作为鉴别T2DM-BSI患者感染类型的生物标志物,hs-CRP和PCT水平越高,感染类型为革兰阴性菌的概率越大;hs-CRP、PCT水平可以反映出致病菌株对所用抗生素的耐药性,需根据临床需求选择合适的抗生素。Objective To explore the relationship between hs-CRP,PCT levels and the type of bloodstream infection(BSI)in patients with type 2 diabetes mellitus(T2DM),and to further provide clinical guidance for antibiotic treatment.Methods A total of 105 patients diagnosed with T2DM-BSI in our hospital from January,2020 to November,2022 were selected as the research objects.According to different types of pathogenic microorganisms,these patients were divided into Gram-positive bacteria group(G+,n=28),Gram-negative bacteria group(G-,n=68),and other-types group(n=9).The general clinical data and laboratory indicators of the above three groups were statistically analyzed.Multivariate logistic regression model and generalized linear mixed effect model(GLMMs)were applied to analyze the relationship between hs-CRP,PCT levels and infection types.According to the efficacy of antibiotics used during the treatment,all patients were divided into the antibiotic effective group(n=65)and antibiotic ineffective group(n=40).Combined with the combined model,the guiding value of hs-CRP and PCT levels on antibiotic treatment was evaluated.Results There were significant differences in the course of disease,also levels of hs-CRP,PCT,C-PR,HDL-C,IL-6 and TNF-αamong the three groups(P<0.05);Logistic regression model and GLMMs regression model showed that hs-CRP and PCT were independent risk factors for the type of infection in T2DM patients with BSI.The lower the levels of hs-CRP and PCT,the higher the probability of infection type in T2DM patients with BSI(P<0.001);The levels of hs-CRP and PCT could reflect the antibiotic resistance in the early stage of treatment.The joint model showed that the risk of antibiotic resistance increased by 0.4%for each 1 longitudinal increase in hs-CRP and 6%for each 1 longitudinal increase in PCT.Conclusion hs-CRP and PCT can serve as biomarkers to identify the type of infection in patients with T2DM-BSI.The higher the levels of hs-CRP and PCT,the higher the probability of infection type is Gram-negative bacteria.

关 键 词：糖尿病 血流感染 感染类型 抗生素 

分 类 号：R587.1[医药卫生—内分泌]