呼吸机相关性肺炎患者感染病原菌分布及炎症反应指标评价

Distribution of pathogens and evaluation of inflammatory response in patients with ventilator-associated pneumonia

目的探讨呼吸机相关性肺炎(VAP)患者感染病原菌分布及炎症反应指标的评价效果。方法选择2015年11月-2017年11月在医院进行治疗的131例机械通气患者,收集年龄、性别、基础疾病等资料进行回顾性分析,探讨血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)和降钙素原(PCT)对于患者是否发生VAP的诊断价值。结果 131例机械通气治疗患者中74例患者发生感染,感染率为56.49%;对74例患者采集的样本共培养出96株致病菌,以革兰阴性菌为主,其次为革兰阳性菌和真菌;感染组患者的血清CRP、PCT、IL-6、IL-10和TNF-α的浓度高于未感染组患者(P<0.05);利用血清CRP、PCT、IL-6、IL-10和TNF-α等炎症反应指标的动态变化对于机械通气患者是否感染进行诊断,最佳截断值分别为10.75mg/L、0.59μg/L、0.68pg/ml、0.71pg/ml和0.59pg/ml,约登指数分别为50.77%、58.77%、50.87%、50.10%和59.00%。结论多种病原菌均可以导致使用机械通气的患者出现感染,其中以革兰阴性菌的比例较高。血清CRP、PCT、IL-6、IL-10和TNF-α对于机械通气的患者是否出现感染均具有一定的诊断价值,但是单种类指标的诊断价值比较有限,应结合多种指标和患者的实际临床情况进行判定。

OBJECTIVE To explore the distribution of pathogens and the evaluation of inflammatory response in patients with ventilator-associated pneumonia (VAP). METHODS 131 patients with mechanical ventilation who were treated in the hospital from Nov. 2015 to Nov. 2017 were enrolled. The data of age, gender, BMI, underlying diseases and serum inflammatory factors were collected and analyzed retrospectively. The diagnostic values of serum C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-αlpha) and procalcitonin (PCT) in patients with VAP were explored. RESULTS Infection was detected in 74 of the 131 patients with mechanical ventilation, and the infection rate was 56.49%. A total of 96 pathogens were cultured from the samples collected from the 74 infected patients, which were mainly gram-negative bacteria, followed by gram-positive bacteria and fungi. The concentrations of serum CRP, PCT, IL-6, IL-10 and TNF-α in the infected group were higher than those in the uninfected group (P<0.05). When the concentrations of serum CRP, PCT, IL-6 , IL-10 and TNF-α were used to diagnose the infection in the mechanical ventilation patients, the optimal cutoff values were 10.75 mg/L, 0.59 μg/L, 0.68 pg/ml, 0.71 pg/ml. 0.59 pg/ml, and the Yoden index values were 50.77%, 58.77%, 50.87%. 50.10%, 59.00%. CONCLUSION A variety of pathogens can lead to infection in patients who use mechanical ventilation, of which the proportion of gram-negative bacteria is relatively high. Serum C-reactive protein, interleukin -6 , tumor necrosis factor - alpha and calcitonin have a certain diagnostic value in the occurrence of infection in patients with mechanical ventilation. However, the diagnostic value of single index is relatively limited, and we should combine multiple indicators and the actual clinical situation of patients during the diagnosis.