重症肝病合并真菌感染尿RNA氧化产物8-氧化鸟苷水平及临床意义

RNA oxidation product 8-oxidated guanosine in urine of severe liver disease patients complicated with nosocomial fungal infection and its clinical significance

目的探究重症肝病合并医院真菌感染患者尿RNA氧化产物8-氧化鸟苷(8-oxoGsn)水平变化及意义。方法选择山东第一医科大学附属济南人民医院67例重症肝病患者,根据医院感染情况分为真菌感染组(n=7)、细菌感染组(n=24)、无感染组(n=36),检测血清感染相关指标[白细胞介素-6(IL-6)、降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)]和尿8-oxoGsn水平。结果67例重症肝病患者发生医院感染31例,共分离出62株病原菌,革兰阳性菌24株,占38.71%,革兰阴性菌31株,占50.00%,真菌7株,占11.29%。细菌感染组、真菌感染组IL-6、PCT、CRP、WBC水平高于无感染组(P<0.05),细菌感染组PCT水平高于真菌感染组(P<0.05);尿8-oxoGsn水平比较为细菌感染组>真菌感染组>无感染组(P<0.05);重症肝病真菌感染患者尿8-oxoGsn水平与IL-6、PCT、CRP、WBC水平正相关(r=0.769、0.845、0.963、0.756,P<0.05);尿8-oxoGsn判断重症肝病是否合并医院感染、鉴别真菌或细菌感染的曲线下面积为0.978、0.780(P<0.05),灵敏度、特异性为87.00%和97.22%,100.00%和58.33%。结论重症肝病合并医院真菌感染患者尿8-oxoGsn与IL-6、PCT、CRP、WBC水平正相关,可用于诊断是否合并医院感染,并鉴别感染病原菌类别。

OBJECTIVE To explore the change of RNA oxidation product 8-oxidated guanosine(8-oxoGsn)in urine of severe liver disease patients complicated with nosocomial fungal infection and analyze its clinical significance.METHODS A total of 67 patients with severe liver diseases who were treated in Jinan People’s Hospital Affiliated to Shandong First Medical University were enrolled in the study and divided into the fungal infection group(n=7),the bacterial infection group(n=24),and the no infection group(n=36).The serological indexes interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)and white blood cell(WBC)as well as urine 8-oxoGsn were detected.RESULTS Of the 67 patients with severe liver diseases,31 had nosocomial infection.Totally 62 strains of pathogens were isolated,24(38.71%)of which were gram-positive bacteria,31(50.11%)were gram-negative bacteria,and 7(11.29%)were fungi.The levels of IL-6,PCT,CRP and WBC of the bacterial infection group and the fungal infection group were significantly higher than those of the no infection group(P<0.05),the PCT level of the bacterial infection group was significantly higher than that of the fungal infection group(P<0.05).The urine 8-oxoGsn level was significantly higher in the bacterial infection group than in the fungal infection group,and which is significantly higher in the fungal infection than in the no infection group(P<0.05).The urine 8-oxoGsn level of the severe disease patients with fungal infection was positively correlated with the levels of IL-6,PCT,CRP and WBC(r=0.769,0.845,0.963,0.756,P<0.05).The area under curve(AUC)of urine 8-oxoGsn was 0.978 in assessment of nosocomial infection,0.780 in differential diagnosis of fungal or bacterial infection(P<0.05);the sensitivity and specificity were respectively 87.00%and 97.22%,100.00%and 58.33%.CONCLUSION The urine 8-oxoGsn of severe liver disease patients complicated with nosocomial fungal infection is positively correlated with the levels of IL-6,PCT,CRP and WBC,which can be used for diagnosis of nosocomial infection and identification of species of pathogens.