HNL在脓毒症患者抗生素使用时机中的应用分析

Analysis of Application of HNL in Antibiotic Use Timing in Sepsis Patients

目的分析人中性粒细胞载脂蛋白(HNL)在脓毒症患者抗生素使用时机中的应用效果。方法选取2018年8月至2020年8月新疆医科大学第六附属医院收治的125例脓毒症患者作为研究对象,根据不同药物应用指导分为HNL组(60例)和常规组(65例)。其中,HNL组根据HNL水平确定抗生素降阶及停用时间,常规组根据白细胞计数、C反应蛋白(CRP)等常规血清学指标水平以及微生物培养结果综合确定抗生素降阶及停用时间,并比较两组患者的抗生素应用时间、病情缓解时间、重症监护病房(ICU)住院时间、ICU住院费用、死亡率(ICU住院期间),治疗前和治疗第3、5、7天的急性生理学和慢性健康状况评价系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分及降钙素原(PCT)、CRP水平。结果HNL组患者的抗生素应用时间、病情缓解时间、ICU住院时间明显短于常规组[(7.5±1.5)d比(11.2±1.8)d、(5.4±1.8)d比(6.7±2.1)d、(8.7±1.6)d比(12.8±1.9)d],ICU住院费用明显少于常规组[(5.2±0.4)万元比(6.1±0.5)万元](均P<0.01)。ICU住院期间,HNL组的死亡率为15.0%(9/60);常规组为21.5%(14/65),两组死亡率比较差异无统计学意义(P>0.05)。两组APACHEⅡ评分与SOFA评分的组间与时点间存在交互作用(P<0.05),治疗第3、5、7天,两组患者的APACHEⅡ评分与SOFA评分均呈先升高后降低趋势,且HNL组均低于常规组(P<0.05)。两组PCT与CRP水平的组间与时点间存在交互作用(P<0.05),治疗第3、5、7天,两组患者的PCT与CRP水平均呈先升高后降低趋势,且HNL组低于常规组(P<0.05)。结论动态检测HNL的表达水平,可避免脓毒症患者非必要的抗生素暴露,提高治疗效果、缩短抗生素应用时间、降低治疗费用。

Objective To analyze the application effect of human neutrophilic lipocalin(HNL)in the timing of antibiotic use in sepsis patients.Methods A total of 125 sepsis patients admitted to the Sixth Affiliated Hospital of Xinjiang Medical University from Aug.2018 to Aug.2020 were included,and divided into an HNL group(60 cases)and a regular group(65 cases)according to different drug application guidance.The antibiotics usage in the HNL group was reduced and withdrawn according to the level of HNL,and the antibiotics usage in the regular group was reduced and withdrawn according to routine serological indexes such as the white blood cell count,C-reactive protein(CRP)level,and microorganism culture results.The antibiotic use time,remission time,the intensive care unit(ICU)stay time length and cost,mortality during ICU stay,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential orginal failure estimator(SOFA)score and procalcitonin(PCT)and CRP levels before treatment and on days 3,5,and 7 of treatment of the two groups were compared.Results The duration of antibiotic application,remission time and ICU stay time in the HNL group were significantly shorter than those in the regular group[(7.5±1.5)d vs(11.2±1.8)d,(5.4±1.8)d vs(6.7±2.1)d,(8.7±1.6)d vs(12.8±1.9)d],and the cost of ICU stay in HNL group was significantly lower than that in the regular group[(5.2±0.4)ten thousand yuan vs(6.1±0.5)ten thousand yuan](all P<0.01).The mortality rate in the HNL group during ICU stay was 15.0%(9/60),in the regular group was 21.5%(14/65),and there was no significant difference between the two groups(P>0.05).Therewere interactions in APACHEⅡscore and SOFA score between groups and time points(P<0.05).On day 3,5 and 7 of the treatment,the APACHEⅡscore and SOFA score in both groups showed a trend of first increasing and then decreasing,and the HNL group was lower than the regular group(P<0.05).There interactions between groups and time points in PCT and CRP levels(P<0.05).On day 3,5 and 7 of treatment,the levels of PCT and CRP in the two groups were firstly increased and then decreased,and those in the HNL group were lower than those in the regular group(P<0.05).Conclusion Dynamic detection of HNL expression level can avoid unnecessary antibiotic exposure in sepsis patients,improve the therapeutic effect,shorten the time of antibiotic application and reduce the treatment cost.