血清炎症因子对血流感染患者病原菌早期鉴别诊断价值研究

Value of serum inflammatory factors in early differential identification of pathogens isolated from patients with bloodstream infections

目的分析血清炎症因子对血流感染患者病原菌早期鉴别诊断的指导价值,以期提升临床血流感染治疗的及时性和准确性。方法选择2015年2月-2016年2月医院收治疑似血流感染患者108例作为研究对象,采集患者静脉血行病原菌培养,同时于入组即刻、入组后6h、24h、7d采集静脉血检测血清炎症因子降钙素原(PCT)、C-反应蛋白(CRP)、白介素-2(IL-2)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子(TNF-α)水平;根据病原菌检测结果,将患者分为感染组和非感染组,感染组患者根据病原菌种类分为细菌感染亚组、真菌感染亚组;比较感染组和非感染组患者及不同感染类型亚组患者间血清炎症因子水平差异。结果感染组和非感染组患者及不同感染类型患者间在年龄、性别、体质量、体质量指数(BMI)、原发疾病比较差异无统计学意义;感染组患者在入组即刻、入组后6h、24h后血清炎症因子指标均明显高于非感染组(P<0.05),且随着时间的推移,PCT、CRP在6h达到最高值,IL-2、IL-6、IL-8、TNF-α在入组后24h达到最高值,随后逐渐下降至正常水平,入组即刻、入组后6h、24h细菌感染患者的血清PCT、CRP、IL-2、IL-6、IL-8、TNF-α均明显高于真菌感染患者(P<0.05)。结论血清炎症因子能在一定程度上反应血流感染患者病原菌构成情况,应进一步对照临床病原菌谱,分析常见致病菌的不同炎症因子间的时效性、浓度水平相关性等,以期进一步提高血清炎症因子对血流感染的鉴别诊断价值。

OBJECTIVE To analyze the value of serum inflammatory factors in early differential identification of pathogens isolated from patients with bloodstream infections so as to improve the timeliness and accuracy of treatment of the bloodstream infections.METHODS A total of 108 patients with suspected bloodstream infections who were treated in the hospital from Feb 2015 to Feb 2016 were recruited as the study objects,the venous blood specimens were drawn from the patients for culture of pathogens,and the levels of serum inflammatory factors procalcitonin（PCT）,C-reactive protein（CRP）,interleukin-2（IL-2）,interleukin-6（IL-6）,interleukin-8（IL-8）and tumor necrosis factor（TNF-α）were detected at the time of enrollment and after the enrollment for 6 hours,24 hours and 7 days.The enrolled patients were divided into the infection group and the non-infection group according to the result of detection of pathogens;the patients of the infection group were divided into the bacterial infection subgroup and the fungal infection subgroup according to the species of pathogens.The levels of the serum inflammatory factors were compared between the infection group and the non-infection group as well as between the subgroups.RESULTS There was no significant difference in the age,gender,body mass,body mass index（BMI）or primary diseases between the infection group and the non-infection group as well as between the subgroups.The levels of serum inflammatory factors of the infection group were significantly higher than those of the non-infection group at the time of enrollment and after the enrollment for 6 hours and 24 hours（P〈0.05）,as time went on,the levels of PCT and CRP were elevated and reached the peak after the enrollment for 6 hours,the levels of IL-2,IL-6,IL-8 and TNF-αreached the peak after the enrollment for 24 hours and then dropped gradually down to the normal level.The levels of serum PCT,CRP,IL-2,IL-6,IL-8 and TNF-αof the patients with bacterial infections were significantly higher than those of the patients with fungal infection at the time of enrollment and after the enrollment for 6 hours and 24 hours（P〈0.05）.CONCLUSION The serum inflammatory factors,to some extent,may reflect the composition of pathogens isolated from the patients with bloodstream infections.It is necessary to observe the timeliness and correlation of concentration levels among the inflammatory factors of the pathogens by further consulting the spectrums of clinical pathogens so as to further improve the value of the serum inflammatory factors in differential diagnosis of the bloodstream infections.