血液病病人与重症监护病人血流感染细菌分布情况及炎症标志物对比分析

Comparative analysis of the bacterial distribution and inflammatory markers of bloodstream infection between hematologic patients and intensive care patients

目的:探讨血液病病人与重症监护病人在血流感染细菌种类、耐药性及C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)等炎症标志物之间有何异同。方法:选取同期同区域血液病医院收治的血液病病人及普通综合医院重症监护病人血培养阳性者分别为血液病组(HDG)和非血液病重症监护组(NHICG),选取同期血液病血培养阴性病人及普通住院病人血培养阴性者分别为血液病对照组(HDCG)和阴性对照组(NCG),检测所有病人的PCT、CRP、WBC等炎症指标水平。再将血液病者分为急性淋巴细胞白血病组(ALLG)、急性髓系白血病组(AMLG)及再生障碍性贫血组(AAG)三个亚组。观察各组之间、亚组之间血培养鉴定、药物敏感实验结果以及各炎症指标的差异。结果:HDG与NHICG 2组的总阳性率比较:前三位均为凝固酶阴性葡萄球菌、肺炎克雷伯菌及亚种、大肠埃希菌,仅排序不同;2组检出的细菌均以革兰阴性菌为主。2组检出阳性率、耐药株数、耐药率居前的细菌仍大致相同。HDG、HDCG、NHICG及NCG 4组间比较,除了NLR外,其他炎症指标差异均有统计学意义(P<0.01)。ALLG、AMLG及AAG 3亚组间各项炎症指标差异均无统计学意义(P>0.05)。结论:血液病病人与重症病人血流感染细菌无论是从检出率还是耐药率方面种类均较为集中;三种常见血液病血流感染细菌种类及耐药类型大致相同;耐甲氧西林凝固酶阴性葡萄球菌已成为血液病人及重症病人常见的革兰阳性致病菌及多重耐药菌。结合PCT、CRP、WBC等炎症标志物对迅速有效鉴别是否为血流感染并甄别污染菌以及血液病病人发展为重症病人的预后监测有一定意义。

Objective:To explore the differences of the bacterial species,drug resistance and inflammatory markers such as C-reactive protein(CRP),procalcitonin(PCT)and white blood cell count(WBC)between hematologic patients and intensive care patients.Methods:In the contemporaneous area,the patients with hematological disease and intensive care patients with positive blood culture were divided into the hematological disease group(HDG)and non-hematological disease group(NHICG),respectivlely,and the patients with hematological disease and intensive care patients with negatvie blood culture were divided into the control group(HDCG)and negative control group(NCG),respectively.The levels of the PCT,CRP and WBC in all cases were detected.The patients with hematologic diseases were subdivided into the acute lymphoblastic leukemia group(ALLG group),acute lymphoblastic leukemia group(AMLG group)and aplastic anemia group(AAG group).The differences of the blood culture identification,drug sensitivity test results and inflammatory indexes among groups and subgroups were observed.Results:Comparison of the total positive rates between HDG and NHICG groups:the top three were coagulase-negative staphylococcus,Klebsiella pneumoniae and subspecies,and Escherichia coli,with only different sequencing.The bacteria in two groups were mainly Gram-negative bacteria.The positive rate,number of drug-resistant strains and bacteria in the top of drug-resistant rate were still roughly the same in the HDG and NHICG groups.Except NLR,the differences of other inflammatory indicators among HDG,HDCG,NHICG and NCG groups were statistically significant(P<0.01).The differences of all inflammatory indicators among ALLG,AMLG and AAG subgroups were not statistically significant(P>0.05).Conclusions:The detection rate and drug resistance rate of bloodstream infection bacteria in patients with hematological diseases and severe patients are relatively concentrated.The types and drug-resistant types of bloodstream infection bacteria in the three common blood diseases are roughly the same.The methicillin-resistant coagulase-negative staphylococcus has become a common Gram-positive pathogenic bacteria and multi-drug resistant bacteria in blood patients and severe patients.The combination of PCT,CRP,WBC and other inflammatory markers is of certain significance for the rapid and effective identification of bloodstream infection.