血流感染患者淋巴细胞减少与病原菌种类及基础疾病的相关研究

Research on the relationship between lymphopenia and the species of pathogenic bacteria and the underlying diseases in patients with bloodstream infection

目的 探讨血流感染患者外周血淋巴细胞减少与病原菌种类和基础疾病的相关关系.方法 采用回顾性研究方法,选择2013-01 ～2015-04入我院诊断的血流感染患者204例,于抽取血培养当日外周血淋巴细胞计数是否＞ 1.0×109/L,分为淋巴细胞＞1.0 ×109/L组（61例）及淋巴细胞＜ 1.0×109/L组（143例）,比较两组患者年龄、性别、细菌种类、APACHEⅡ评分、合并症等,并行Logistic回归分析影响淋巴细胞减少的因素.结果 ①两组患者年龄、性别、白蛋白、前白蛋白水平、血红蛋白、血肌酐、血磷、D-Dimer水平及合并脑血管病、冠心病、心功能不全、糖尿病、肾功能不全、肝功能异常的例数等比较差异无统计学意义（P＞0.05）;淋巴细胞＜1.0×109/L组患者降钙素原水平及合并肠球菌感染、合并外科术后、合并肿瘤的例数明显高于淋巴细胞＞ 1.0×109/L组（P＜0.05）.②肠球菌血流感染最常见于腹腔感染（57.1％）,其次为肺部感染（14.3％）和导管感染（19.0％）;葡萄球菌血流感染最常见于肺部感染（58.6％）,其次为导管感染（24.1％）、腹腔感染（10.3％）.③Logistic回归分析发现,年龄、是否合并肿瘤及低磷血症是淋巴细胞减少的独立影响因素（P＜0.05）.结论 血流感染患者常常合并淋巴细胞减少（70.1％）,腹腔感染合并低淋巴细胞血症需要警惕肠球菌感染,年龄、合并肿瘤、低磷血症与血流感染患者淋巴细胞减少密切相关.

Objective To investigate the relationship between peripheral blood lymphocyte count and pathogenic bacteria species and underlying diseases in patients with bloodstream infection.Methods 204 patients with bloodstream infection were collected in our hospital ICU from January 2013 to April 2015 through a prospective study.Blood samples for peripheral total lymphocyte count were taken on the day of taking blood for the culture,according to peripheral total lymphocyte count was greater than 1.0 × 109/L,divided into lymphocyte ＞ 1.0 × 109/L group （61 cases） and lymphocyte ＜ 1.0 × 109/L group （n =143）.The patients＇ age,gender,bacterial species,APACHE Ⅱ score,comorbidities and other differences were compared between the two groups,the rish factors affecting lymphopenia were analyzed by multivariate Logistic regression.Results The age,gender,albumin,pre-albumin concentrations,HGB,serum creatinine,serum phosphorus,D-dimer concentrations and comorbidities with cerebrovascular diseases,coronary heart disease,heart failure,diabetes mellitus,renal dysfunction,liver function abnormal in the lymphocyte ＜ 1.0 × 109/L group were not significantly different compared with those in the lymphocyte ＞ 1.0 × 109/L group （P ＞ 0.05）;The procalciton in concentrations,proportion of enterococcal infection and proportion of associated with surgery or tumor in the lymphocyte ＜ 1.0 × 109/L group were statistically significant higher than those in the lymphocyte ＞ 1.0 × 109/L group （P ＜ 0.05）.Enterococcal bloodstream infection in abdominal infection accounted for the major part （57.1％）,followed by pulmonary infection （14.3％） and catheter-related infection （19.0％）;Staphylococcus aureus bloodstream infection with pulmonary infection （58.6％）,abdominal infection （10.3％）,catheter infection （24.1％）;Pseudomonas aeruginosa bloodstream infection occurred only in pulmonary infection.The Logistic regression analysis showed that age,tumor and hypophosphoremia were independent predictors of lymphopenia （P ＜ 0.05）.Conclusion Patients with bloodstream infection are often associated with lymphopenia （70.1％）,when infection of abdominal combined with lymphopenia existence,we need to guard against enterococcus infection.The age,tumor and hypophosphoremia closely related to the lymphopenia with bloodstream infection.