放射性肺炎合并感染患者炎症指标检测病原菌分布特征及感染相关危险因素分析

Determination of inflammatory indexes and analysis of the distribution of pathogens and risk factors for infection in patients with radiation pneumonitis

目的检测放射性肺炎合并感染患者炎症指标及感染病原菌种类,并分析感染相关危险因素。方法选择2017年1月~2019年10月本院收治的放射性肺炎患者112例,根据是否合并感染分成感染组(56例)和未感染组(56例),检测和对比分析两组患者炎症指标水平以及感染组患者感染病原菌种类,并通过Logistic回归法分析放射性肺炎合并感染的独立危险因素。结果感染组患者血PCT、CRP及WBC分别为(2.23±1.51)ng/ml.(10.07±1.94)mg/L和(1.22±0.31)×10^9/L,对照组分别为(0.96±0.16)ng/ml、(5.63±1.07)mg/L和(2.40±0.38×10^9/L,差异均有统计学意义(均P<0.05)。56例感染患者痰培养分离出病原菌65株,其中革兰阳性菌23株,以金黄色葡萄球菌(18.46%)和表皮普通球菌(12.31%)为主;革兰阴性菌26株,以大肠埃希菌(23.08%)和肺炎克雷伯杆菌(9.23%)为主;真菌检出16株,以白色念珠菌(18.46%)为主。经Logistic多因素分析,年龄≥45岁、血WBC<2.0×10^9/L、放疗照射体积≥25.0%以及KPS评分<70分均为放射性肺炎患者合并感染发生的独立危险因素(均P<0.05)。结论放射性肺炎患者合并感染的病原菌种类广泛,需依据药敏试验结果选择敏感抗菌药物治疗。在感染的预防方面,需重点关注患者可能存在的相关危险因素,及时采取有效措施减少感染的发生。

Objectives To determine inflammatory indices and to analyze the distribution of pathogens and risk factors for infection in patients with radiation pneumonitis. Methods Subjects were 112 patients with radiation pneumonitis who were seen at this Hospital from January 2017 to October 2019.Depending on whether or not patients had an infection,they were divided into those with an infection(56 patients)and those without an infection(56 patients).Venous blood samples were collected in the morning to determine the inflammatory indexes,and sputum samples were collected to detect pathogens.Inflammatory indices were determined and compared between the two groups,the distribution of pathogens in patients with an infection was analyzed,and the risk factors for development of an infection were analyzed using logistic regression. Results In patients with an infection,PCT was 2.23±1.51 ng/ml,CRP was 10.07±1.94 mg/L,and the WBC count was 1.22±0.31×10^9/L.In the control group,PCT was 0.96±0.16 ng/ml,CRP was 5.63±1.07 mg/L,and the WBC count was 2.40±0.38×10^9/L.Differences in the levels and count were significant(P<0.05 for all).Sixty-five strains of pathogens were isolated from 56 patients with an infection.Twenty-three strains were Gram-positive bacteria,which were mainly Staphylococcus aureus(18.46%)and S.epidermidis(18.46%).Twenty-six strains were Gram-negative bacteria,which were mainly Escherichia coli(23.08%)and Klebsiella pneumoniae(9.23%).Sixteen strains were fungi,which were mainly Candida albicans(12.46%).According to logistic multivariate analysis,an age≥45 years,a leukocyte count<2.0×10^9/L,an irradiation volume≥25.0%,and a KPS score<70 were independent risk factors for nosocomial infection in patients with radiation pneumonitis(P<0.05). Conclusion A wide range of pathogens infected patients with radiation pneumonitis,so sensitive antimicrobials should be selected according to the results of a drug sensitivity test.To prevent infection,more attention should be paid to related risk factors in patients,and effective measures should be taken to reduce the incidence of infection.