社区获得性肺炎患者感染病原菌特点及凝血、纤溶相关指标水平分析

Serum levels of indices related to coagulation and fibrinolysis in patients with more or less severe CAP and analysis of characteristics of pathogens related to CAP

目的探讨不同严重程度社区获得性肺炎患者感染病原菌特点及凝血、纤溶相关指标水平。方法选取.2016年3月至2018年5月在本院接受治疗的社区获得性肺炎患者113例,根据肺炎严重程度指数分为低风险组(67例)及中高风险组(46例)。同时选择53例体检健康者作为健康对照组。收集患者痰液进行细菌培养并做药敏试验;采集患者静脉血,分离血清,采用ELISA法检测炎症、凝血及纤溶相关指标水平。结果113例社区获得性肺炎患者痰标本共分离出细菌108株,其中革兰阴性菌占71.30%,革兰阳性菌占25.93%,真菌占2.78%。药敏试验显示,主要革兰阴性菌中的肺炎克雷伯菌和主要革兰阳性菌中的金黄色葡萄球菌对头孢哌酮舒巴坦及亚胺培南均敏感。与健康对照组相比,病例组血清降钙素原(PCT)和C反应蛋白(CRP)、活化部分凝血活酶时间(APTT)、组织纤溶酶原激活物(t PA)、纤溶酶原激活物抑制物-1(PAI-1)及D-二聚体(D-D)水平均增高(P<0.05),且病情越重增设更显著;凝血酶时间(TT)水平下降(P<0.05),且病情越重下降越显著。结论社区获得性肺炎患者感染致病菌多数为革兰阴性菌,革兰阴性菌中的肺炎克雷伯菌和革兰阳性菌中的金黄色葡萄球菌对头孢哌酮舒巴坦及亚胺培南均敏感,炎症、凝血及纤溶相关指标水平与社区获得性肺炎患者的严重程度相关,可为该病的诊断和治疗提供参考。

Objective To explore the characteristics of pathogens and the levels of indicators related to coagulation and fibrinolysis in patients with more or less severe community acquired pneumonia.Methods Subjects were 113 patients with community acquired pneumonia treated at this Hospital from March 2016 to May 2018.In accordance with indicators of the severity of pneumonia,patients were divided into a low-risk group(67 cases)and a high-risk group(46 cases).Fifty-three healthy persons were selected to serve as the healthy control group.Sputum was collected from patients for microbial culture and drug sensitivity testing,and serum was collcted to measure the levels of indicators related to in-flammation,coagulation,and fibrinolysis.Results One hundred and eight strains of pathogens were isolated from 113 patients with community-acquired pneumonia.Gram-negative bacteria accounted for 71.30%,Gram positive bacteria ac-counted for 25.93%,and fungi accounted for 2.78%.Community-acquired pneumonia was most often caused by Gram-negative bacteria.The main Gram-negative bacterium and the main Gram-positive bacterium were both sensitive to cef-operazone sulbactam and imipenem.There were significant differences in the levels of indicators of inflammation,coagula-tion,and fibrinolysis among the three groups(P<0.05).The levels of inflammatory markers[including procalcitonin(PCT)and C reactive protein(CRP)],the activated partial thromboplastin time(APTT),and fibrinolytic markers[in-cluding tissue plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1),and D-dimer(D-D)]tended to increase in the three groups.Indicators in the high-risk group(1.72±0.76,111.50±40.45,36.45±5.36,7.17±1.80,51.63±8.87,and 2.27±0.84)were significantly higher than those in the low-risk group(0.39±0.11,67.84±25.20,33.76±4.10,6.29±1.68,38.68±9.13,and 1.30±0.43)or the healthy group(0.04±0.02,6.45±1.50,31.64±3.31,5.07±1.38,35.33±7.33,and 0.27±0.09)(P<0.05),and indicators in the low-risk group were signifi-cantly higher than those in the healthy group(P<0.05).In contrast,the thrombin time(TT)tended to decrease in the three groups.TT in the high risk group(13.16±2.45)was significantly shorter than that in the low risk group(15.20±1.31)or the healthy group(17.24±1.86)(P<0.05),and TT in the low-risk group was significantly shorter than that in the bhealthy group(P<0.05).Conclusion Gram negative bacteria are the main pathogens causing community-acquired pneumonia.The main Gram-negative bacterium and Gram-positive bacterium were both sensitive to cefoperazone sulbactam and imipenem.The levels of indicators of inflammation,coagulation,and fibrinolysis were correlated with the severity of community-acquired pneumonia.