冠心病患者PCI术后感染病原菌分布特征及支架内再狭窄的影响因素分析

Analysis of Distribution Characteristics of Pathogenic Bacteria and Factors Influencing In-stent Restenosis in Patients with Coronary Heart Disease after PCI

目的:研究冠心病患者经皮冠状动脉介入(PCI)术后感染病原菌分布特征及支架内再狭窄(ISR)的影响因素。方法:纳入从2015年1月~2018年1月于我院接受PCI术治疗的冠心病患者460例作为研究对象。采集PCI术后发生感染患者感染部位的分泌物或血液标本,分析病原菌分布特征。此外,将所有患者按照PCI术后是否存在ISR分成ISR组120例与非ISR组340例。比较两组基线资料、生化指标水平,并采用多因素Logistic回归分析影响ISR的危险因素。结果:29例患者发生医院感染,共培养分离获得病原菌38株,其中革兰阴性菌13株,占比34.21%,革兰阳性菌22株,占比57.89%,真菌3株,占比7.89%。ISR组男性、糖尿病、吸烟史人数占比均显著高于非ISR组(均P<0.05)。ISR组空腹血糖(FPG)、总胆固醇(TC)、血尿酸(UA)、超敏C反应蛋白(hs-CRP)水平均显著高于非ISR组(均P<0.05)。经多因素Logistic回归分析可得:糖尿病、吸烟史、TC(较高)、UA(较高)、hs-CRP(较高)均是影响ISR的危险因素(均P<0.05)。结论:引起冠心病患者PCI术后感染的病原菌以革兰阳性菌为主,冠心病患者合并糖尿病、吸烟史以及随着TC、UA、hs-CRP水平的升高,PCI术后ISR的发生风险随之增加。

Objective:To study the distribution characteristics of pathogenic bacteria after percutaneous coronary intervention(PCI)and the influencing factors of in-stent restenosis(ISR)in patients with coronary heart disease.Methods:460 patients with coronary heart disease who received PCI in our hospital from January 2015 to January 2018 were enrolled as the study subjects.Secretions or blood samples were collected from infected patients after PCI,and the distribution characteristics of pathogens were analyzed.In addition,all patients were divided into 120 patients in the ISR group and 340 patients in the non-ISR group according to whether there was an ISR after PCI.Two groups of baseline data,biochemical index level were compared.Multivariate Logistic regression was used to analyze the risk factors of ISR.Results:In 29 patients with nosocomial infection,38 strains of pathogenic bacteria were isolated and cultured,among which 13 strains of gram-negative bacteria,accounted for 34.21%,22 strains of gram-positive bacteria,accounted for 57.89%,and 3 strains of fungi,accounted for 7.89%.The proportion of male,diabetes and smoking history in ISR group were significantly higher than those in non-ISR group(all P<0.05).Fasting plasma glucose(FPG),total cholesterol(TC),uric acid(UA)and hypersensitive C-reactive protein(hs-CRP)levels in ISR group were significantly higher than those in non-ISR group(all P<0.05).Multivariate Logistic regression analysis showed that diabetes,smoking history,TC(higher),UA(higher)and hs-CRP(higher)were all risk factors for the occurrence of ISR.Conclusion:Gram-positive bacteria are the main pathogens causing infection after PCI in patients with coronary heart disease,and the risk of ISR after PCI increases with diabetes,smoking history and the increase of TC,UA and hs-CRP levels.