不同病原菌所致血流感染患者炎症及凝血指标水平研究

Study on the Levels of Inflammation and Coagulation Indexes in Patients with Bloodstream Infections Caused by Different Pathogens

目的探讨不同病原菌(C^(+)、C^(-))所致的血流感染患者的炎症指标及凝血指标如白细胞计数(WBC),降钙素原(PCT),C反应蛋白、纤维蛋白原等水平差异,为血流感染患者抗生素选择提供理论依据。方法便利选取2018年1月-2019年6月在厦门医学院附属第二医院接受治疗并满足纳入标准的血流感染患者77例,根据病原菌种类将患者分为革兰阴性菌组(C^(-))和革兰阳性菌组(C^(+)),比较两组间患者的WBC、NE%、LY%、MO%,PCT,CRP,PT、APTT、纤维蛋白原的水平。结果两组患者体温差异无统计学意义(t=0.741,P>0.05)。两组患者血清PCT水平差异有统计学意义(t=17.950,P<0.05);两组患者血WBC、NE%、LY%、,MO%,CRP,PT,APTT、纤维蛋白原的水平差异无统计学意义(t=1.232,0.320,0.350,1.465,0.081,0.294,0.609、1.891,P>0.05)。结论血流感染患者降钙素原水平升高明显提示为革兰阴性菌感染,降钙素原水平升高不明显提示革兰阳性菌感染。纤维蛋白原水平较正常值明显升高的血流感染为阳性菌感染的可能性较大。

Objective To explore the inflammatory and coagulation indicators of patients with bloodstream infections caused by different pathogens(G+,G-)such as white blood cell count(WBC),procalcitonin(PCT),C-reactive protein,fibrinogen,etc.The difference in level provides a theoretical basis for the selection of antibiotics for patients with bloodstream infection.Methods From January 2018 to June 2019,convenient select 77 patients with bloodstream infection who were treated at the Second Affiliated Hospital of Xiamen Medical College and met the inclusion criteria were selected.According to the type of pathogenic bacteria,the patients were divided into gram-negative bacteria group(G-)and leather Blue-positive bacteria group(G+),compare the levels of WBC,NE%,LY%,MO%,PCT,CRP,PT,APTT,and fibrinogen between the two groups.Results There was no statistically significant difference in body temperature between the two groups(t=0.741,P>0.05).The difference in serum PCT levels between the two groups was statistically significant(t=17.950,P<0.05);there was no statistically difference in the levels of WBC,NE%,LY%,MO%,CRP,PT,APTT,and fibrinogen between the two groups(t=1.232,0.320,0.350,1.465,0.081,0.294,0.609,1.891,P>0.05).Conclusion In patients with bloodstream infection,an increase in the level of procalcitonin clearly indicates a Gram-negative bacterial infection,and an increase in the level of procalcitonin does not indicate a Gram-positive infection.A bloodstream infection with a significantly higher fibrinogen level than normal is more likely to be a positive bacterial infection.