血清炎症因子水平对老年COPD医院血流感染诊断及预后影响

EFFECTS OF SERUM INFLAMMATORY FACTORS ON THE DIAGNOSIS AND PROGNOSIS OF NOSOCOMIAL BLOODSTREAM INFECTION IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

目的 分析血清炎症因子水平对老年慢性阻塞性肺疾病(COPD)医院血流感染病人诊断及临床预后的影响。方法 选取COPD病人118例,根据有无合并医院血流感染分为感染组50例及非感染组68例,并根据病人治疗1周内是否死亡分为死亡组34例和存活组84例,同期选择门诊健康体检者125例作为对照组。检测并比较各组血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及降钙素原(PCT)水平;评价COPD病人急性生理学及慢性健康状况(APACHEⅡ),并分析其与血清指标的相关性,血清炎症因子水平对COPD医院血流感染病人预后的价值。结果 COPD组CRP、TNF-α、IL-6、IL-8及PCT水平均高于对照组(t=53.765~67.732,P<0.05),COPD血流感染组各血清炎症因子水平高于非感染组(t=16.397~70.701,P<0.05),COPD死亡组各血清炎症因子水平高于存活组(t=22.020~77.440,P<0.05)。COPD医院血流感染病人血清CRP、TNF-α、IL-6、IL-8及PCT水平与APACHEⅡ评分均呈正相关(r=0.521~0.694,P<0.05)。CRP、TNF-α、IL-6、IL-8及PCT受试者操作特性曲线(ROC)下面积分别为0.843、0.744、0.603、0.790、0.645,联合指标曲线下面积为0.951,联合指标曲线下面积明显高于单个指标。结论 血清炎症因子水平可作为老年COPD医院血流感染诊断及预后评估的参考指标。

Objective To analyze the effects of serum inflammatory factors on the diagnosis and clinical prognosis of nosocomial bloodstream infection in elderly patients with chronic obstructive pulmonary disease(COPD). Methods A total of 118 patients with COPD were enrolled.They were divided into infection group(n=50)and non-infection group(n=68)according to the presence or absence of nosocomial bloodstream infection,and were divided into death group(n=34)and survival group(n=84)according to whether the patient died within 1 week of treatment.Another 125 healthy individuals who underwent physical examination during the same period were selected as control group.Then levels of serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),and procalcitonin(PCT)were measured and compared between groups.The Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score of patients with COPD was determined,and its correlation with serum indices was analyzed.The value of serum inflammatory factor level in evaluating the prognosis of nosocomial bloodstream infection in elderly patients with COPD was analyzed. Results The levels of CRP,TNF-α,IL-6,IL-8,and PCT in the COPD group were significantly higher than those in the control group(t=53.765-67.732,P<0.05).In the COPD patients,the levels of serum inflammatory factors in the bloodstream infection group were significantly hi-gher than those in the noninfection group(t=16.397-70.701,P<0.05);the levels of serum inflammatory factors in the death group were significantly higher than those in the survival group(t=22.020-77.440,P<0.05).In the COPD patients with nosocomial bloodstream infection,levels of serum CRP,TNF-α,IL-6,IL-8,and PCT were positively correlated with APACHE Ⅱ score(r=0.521-0.694,P<0.05).The areas under the receiver operating characteristic curves of CRP,TNF-α,IL-6,IL-8,PCT,and a combination of the above indices were 0.843,0.744,0.603,0.790,0.645,and 0.951,respectively,suggesting that the area under the curve of a combination of indices was significantly larger than that of the single indicator. Conclusion Levels of serum inflammatory factors can be used as reference indices for the diagnosis and prognostic evaluation of nosocomial bloodstream infection in elderly patients with COPD.