血流细菌感染致脓毒症患者血清炎症因子与凝血指标的变化

Changes of serum inflammatory factors and coagulation parameters in patients with sepsis caused by bloodstream bacterial infection

目的探究血流细菌感染致脓毒症患者血清炎症因子与凝血指标的变化。方法选取63例血流细菌感染致脓毒症患者为研究对象,按照血培养结果分为革兰阳性菌血流感染组(G+菌血流感染组)22例和革兰阴性菌血流感染组(G-菌血流感染组)41例,并随机选取同期50例健康体检者作为对照组。比较各组降钙素原(PCT)、C反应蛋白(CRP)水平、D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、抗凝血酶Ⅱ(ATⅡ)、血栓弹力指标最大振幅(MA)及凝血综合指数(CI)水平。结果G-菌血流感染组的血清炎症因子PCT水平、CRP水平明显高于G+菌血流感染组和对照组,G+菌血流感染组的血清炎症因子PCT水平、CRP水平明显高于对照组(LSD-t分别=3.47、6.92、5.86、7.02、7.24、7.97,P均<0.05)。G-菌血流感染组的D-D水平、PT、APTT、TT、MA明显高于G+菌血流感染组和对照组,而FIB、ATⅡ、CI明显低于G+菌血流感染组和对照组(LSD-t分别=6.94、5.68、3.74、2.75、6.32、2.96、3.06、4.02;9.26、8.95、7.92、7.95、7.95、6.25、8.74、8.46,P均<0.05);G+菌血流感染组的D-D水平、PT、APTT、TT、MA明显高于对照组,而FIB、ATⅡ、CI明显低于对照组(LSD-t分别=8.96、7.96、6.83、7.06、7.03、5.38、8.36、7.90,P均<0.05)。G+菌血流感染组和G-菌血流感染组中的重症脓毒症患者的PCT、CRP、D-D、PT、APTT、TT、MA水平均高于非重症患者,而FIB、ATⅡ、CI水平则低于非重症患者(t分别=2.18、2.63、8.17、4.93、12.02、7.68、5.02、2.17、4.63、3.97;4.01、9.18、9.00、6.19、13.50、10.78、4.63、3.90、6.19、4.62,P均<0.05)。结论血清炎症因子PCT、CRP以及凝血指标D-D、PT、APTT、TT、FIB、ATⅡ、MA、CI的水平与血流细菌感染致脓毒症患者病情严重程度相关。

Objective To investigate the changes of serum inflammatory factors and coagulation indexes in patients with sepsis caused by bloodstream bacterial infection.Methods Sixty-three patients with sepsis caused by bloodstream bacterial infection were selected as research objects.According to the results of blood culture,they were divided into 22 cases of Gram-positive bacterial bloodstream infection group and 41 cases of Gram-negative bloodstream infection group,and randomly selected 50 healthy physical examination as the control group.Compare the levels of procalcitonin(PCT),C-reactive protein(CRP),D-dimer(DD),prothrombin time(PT),activated partial thromboplastin time(APTT),and thrombin time(TT),fibrinogen(FIB),antithrombinⅡ(ATⅡ),maximum amplitude of thrombus elasticity index(MA),and coagulation composite index(CI)levels.Results The serum inflammatory factor PCT and CRP levels in the Gramnegative bacterial bloodstream infection group were significantly higher than those in the Gram-positive bacterial bloodstream infection group and the control group,and the serum inflammatory factor PCT and CRP levels in the Gram-positive bacteria bloodstream infection group were significantly higher than those in the control group(LSD-t=3.47,6.92,5.86,7.02,7.24,7.97,P<0.05).The levels of DD,PT,APTT,TT,and MA in the Gram-negative bacterial bloodstream infection group were significantly higher than those in the Gram-positive bacteria bloodstream infection group and the control group,while the FIB,ATⅡ,and CI were significantly lower than those in the G-positive bacteria bloodstream infection group and the control group(LSD-t=6.94,5.68,3.74,2.75,6.32,2.96,3.06,4.02;9.26,8.95,7.92,7.95,7.95,6.25,8.74,8.46,P<0.05).DD levels,PT,APTT,TT,and MA in G-positive bacterial bloodstream infection group were significantly higher than those in the control group,while FIB,ATⅡ,and CI were significantly lower than those in the control group(LSDt=8.96,7.96,6.83,7.06,7.03,5.38,8.36,7.90,7.90,P<0.05).The levels of PCT,CRP,DD,PT,APTT,TT,and MA in severe sepsis patients in the G-positive bacterial bloodstream infection group and the G-negative bacterial bloodstream infection group were higher than those in the non-severe patients,while the levels of FIB,ATII,and CI Is lower than nonsevere patients(t=2.18,2.63,8.17,4.93,12.02,7.68,5.02,2.17,4.63,3.97;4.01,9.18,9.00,6.19,13.50,10.78,4.63,3.90,6.19,4.62,P<0.05).Conclusion The levels of serum inflammatory factors PCT,CRP and coagulation indicators D-D,PT,APTT,TT,FIB,ATⅡ,MA,CI are related to the severity of sepsis in patients with bloodstream bacterial infection.