老年心力衰竭患者肺部感染的病原菌分布及对血清降钙素原水平的影响研究

Distribution of pathogens causing pulmonary infections in elderly patients with heart failure and influence on serum procalcitonin

目的对老年心力衰竭合并肺部感染患者病原菌分布进行分析,观察患者感染后心肺功能的变化,并探讨炎性因子在合并肺部感染的心力衰竭患者中的水平,为临床诊疗提供参考。方法分析2015年1月-2016年6月医院就诊的老年心力衰竭合并肺部感染患者的临床资料。依据患者是否并发感染将患者分为感染组(74例)及非感染组(78例),同时纳入同期健康体检者作为对照组(84例),进行病原菌鉴定分型,分析患者感染后心肺功能的变化,并比较各组外周血炎症指标。结果 74例感染组患者共分离致病菌112株,其中革兰阴性菌81株(72.32%),革兰阳性菌29株(25.89%),真菌2株(1.79%);感染组患者的FVC、FEV1、FEV1/FVC、DLCO及MMEF的肺功能指标与未感染组及对照组相比差异具有统计学意义(P<0.05);感染组患者LVEF、LVEDD及LVESD的心功能指标与未感染组及对照组相比差异具有统计学意义(P<0.05);感染组患者外周血BNP、CRP、IL-6及PCT水平均高于未感染组及对照组,差异具有统计学意义(P<0.05)。结论合并肺部感染的老年心力衰竭患者以革兰氏阴性菌感染为主,且感染后患者心肺功能受到明显影响;患者合并肺部感染后,其血清炎症因子水平也升高,对判断感染程度具有一定辅助价值。

OBJECTIVE To investigate the distribution of pathogens isolated from elderly heart failure patients complicated with pulmonary infections,observe the change of cardiopulmonary function and explore the levels of inflammatory factors in the heart failure patients complicated with pulmonary infections so as to provide guidance for clinical diagnosis and treatment.METHODS The clinical data of elderly heart failure patients complicated with pulmonary infections who were treated in the hospital from Jan 2015 to Jun 2016 were analyzed,the patients were divided into the infection group with 74 cases and the non-infection group with 78 cases according to the status of complication with infection,meanwhile,84 healthy people who received physical examination were chosen as the control group.The isolated pathogens were identified,the change of cardiopulmonary function was observed,and the levels of peripheral blood inflammatory indexes were compared among the three groups.RESULTS Totally 112 strains of pathogens were isolated from 74 patients of the infection group,81（72.32%）of which were gram-negative bacteria,29（25.89%）were gram-positive bacteria,and 2（1.79%）were fungi.There were significant differences in the FVC,FEV1,FEV1/FVC,DLCO and MMEF among the infection group,the non-infection group and the control group（P〈0.05）.There were significant differences in the cardiac function indexes LVEF,LVEDD and LVESD among the infection group,the non-infection group and the control group（P〈0.05）.The levels of peripheral blood BNP,CRP,IL-6 and PCT of the infection group were significantly higher than those of the noninfection group and the control group（P〈0.05）.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the elderly heart failure patients complicated with pulmonary infections,and the pulmonary infection has remarkable impact on the cardiopulmonary function.The levels of the serum inflammatory factors of the patients complicated with pulmonary infections are elevated,which has certain value in auxiliary diagnosis of the infections.