内镜下黏膜剥离术后肺部感染病原菌及血清CRP、IL-6和PCT的预测价值  

Pathogenic bacteria isolated from endoscopic submucosal dissection patients with postoperative pulmonary infection and predictive values of serum CRP,IL-6 and PCT

作　　者：姚海欣[1] 王惠[1] 曹轶琼 YAO Haixin;WANG Hui;CAO Yiqiong(The First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第一医院消化内科,浙江温州325000

出　　处：《中华医院感染学杂志》2025年第5期652-656,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2018KY512)。

摘　　要：目的分析内镜下黏膜剥离术(ESD)后肺部感染患者病原菌分布情况,探讨血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)和降钙素原(PCT)对肺部感染的预测价值。方法选取2022年12月-2023年12月于温州医科大学附属第一医院接受ESD治疗的246例患者为研究对象,根据其术后是否发生肺部感染分为感染组50例和非感染组196例。收集感染组痰液标本进行病原菌鉴定;分析ESD术后肺部感染发生危险因素;对比感染组与非感染组血清CRP、IL-6和PCT含量,分析其表达对ESD术后肺部感染的预测价值。结果50例感染患者共分离出病原菌67株,其中革兰阳性菌共21株占比31.34%,革兰阴性菌共37株占比55.22%,真菌共9株占比13.43%。年龄≥60岁(OR=4.785)、合并糖尿病(OR=20.627)、手术时间≥60 min(OR=19.643)、卧床时间≥1周(OR=38.641)是ESD术后肺部感染的危险因素(P<0.05)。感染组与非感染组术后血清CRP、IL-6和PCT水平比较,差异有统计学意义(P<0.05)。血清CRP、IL-6和PCT联合预测ESD术后肺部感染的灵敏度为96.00%,特异度为83.67%,AUC值为0.898,优于CRP、IL-6和PCT单独预测(P<0.05)。结论ESD术后肺部感染风险较高,革兰阴性菌是其主要感染病原菌;ESD术后肺部感染发生的影响因素较多,CRP、IL-6和PCT对ESD术后肺部感染发生有一定预测价值。OBJECTIVE To observe the distribution of pathogens isolated from the endoscopic submucosal dissection(ESD)patients with postoperative pulmonary infections and explore the values of serum C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)in prediction of the pulmonary infection.METHODS A total of 246 patients who received ESD in the First Affiliated Hospital of Wenzhou Medical University from Dec.2022 to Dec.2023 were recruited as the research subjects and were divided into the infection group with 50 cases and the non-infection group with 196 cases according to the status of postoperative pulmonary infection.The sputum specimens were collected from the patients of the infection group,the isolated pathogens were identified.The risk factors for the postoperative pulmonary infection in the ESD patients were analyzed.The levels of serum CRP,IL-6 and PCT were compared between the infection group and the non-infection group.The values of the indexes in prediction of the postoperative pulmonary infection in the ESD patients were observed.RESULTS Totally 67 strains of pathogens were isolated from the 50 patients with infection,21(31.34%)of which were gram-positive bacteria,37(55.22%)were gram-negative bacteria,and 9(13.43%)were fungi.The no less than 60 years of age(OR=4.785),complication with diabetes mellitus(OR=20.627),operation duration no less than 60 min(OR=19.643)and bedridden time no less than1 week(OR=38.641)were the risk factors for the postoperative pulmonary infection in the ESD patients(P<0.05).There were significant differences in the levels of serum CRP,IL-6 and PCT between the infection group and the non-infection group(P<0.05).The sensitivity of the joint detection of serum CRP,IL-6 and PCT was 96.00%in prediction of the postoperative pulmonary infection in the ESD patients,with the specificity 83.67%,the AUC value 0.898,which were superior to the single detection of CRP,IL-6 and PCT(P<0.05).CONCLUSIONS The ESD patients are at high risk of postoperative pulmonary infection.The gram-negativ

关 键 词：内镜下黏膜剥离术 消化道肿瘤 肺部感染 病原菌 C-反应蛋白 白细胞介素-6 降钙素原 

分 类 号：R619.3[医药卫生—外科学]