耐碳青霉烯类肺炎克雷伯菌感染与急性胰腺炎严重程度的临床关系

Clinical relationship between carbapenem-resistant Klebsiella pneumoniae infection and the severity of acute pancreatitis

目的探讨耐碳青霉烯类肺炎克雷伯菌(CRKP)感染与急性胰腺炎严重程度的临床关系。方法采用回顾性描述性研究。收集2017年1月至2018年1月浙江大学医学院附属邵逸夫医院收治的109例急性胰腺炎病人的临床资料;男66例,女43例;年龄为(48±17岁)。无菌采集病人血液、体液或肛拭子样本。病人经综合诊断,分别行胆囊穿刺引流、鼻胆管引流、手术清创以及CT检查介入引流或保守治疗。观察指标:(1)急性胰腺炎严重程度和CRKP检测结果。(2)CRKP感染对急性胰腺炎严重程度的诊断价值。(3)急性胰腺炎治疗方式。(4)预后情况。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布计量资料以M(范围)。计数资料以绝对数表示,组间比较采用χ^(2)检验。相关性检验采用Spearman相关分析,采用受试者工作特征(ROC)曲线评价诊断价值。结果(1)急性胰腺炎严重程度和CRKP检测结果:109例病人中,轻度急性胰腺炎37例、中重度急性胰腺炎8例、重度急性胰腺炎64例;轻症45例,重症64例;CRKP阳性48例,CRKP阴性61例。45例轻症病人中,CRKP阳性3例;64例重症病人中,CRKP阳性45例,两者比较,差异有统计学意义(χ^(2)=43.430,P<0.05)。皮尔逊相关分析:CRKP阳性与急性胰腺炎严重程度呈正相关(r=0.631,P<0.05)。CRKP阳性和阴性病人住院时间分别为(66±6)d和(24±3)d,两者比较,差异有统计学意义(t=47.661,P<0.05)。(2)CRKP感染对急性胰腺炎严重程度的诊断价值:CRKP阳性诊断重度急性胰腺炎的ROC曲线下面积、灵敏度、特异度分别为0.799(95%可信区间为0.714~0.885,P<0.05)、0.688、0.911。(3)急性胰腺炎治疗方式:109例病人中,行鼻胆管引流17例、行胆囊穿刺引流19例、行手术清创42例、行CT检查介入引流48例、保守治疗43例,同1例病人可行多种治疗。109例病人中,行≥1种有创治疗66例,CRKP阳性47例;未行有创治疗43例,CRKP阳性1例;两者比较,差异有统计学意义(χ^(2)=50.134,P<0.05)。(4)预后情况:109例病人均获得随访,随访时间为3~9个月,中位随访时间为6个月。随访期间,48例CRKP阳性病人中,15例死亡;61例CRKP阴性病人中,6例死亡;两者比较,差异有统计学意义(χ^(2)=7.919,P<0.05)。结论CRKP阳性与急性胰腺炎严重程度呈正相关,CRKP阳性与住院时间以及操作次数和种类越多有关。

Objective To investigate the clinical relationship between carbapenem-resistant Klebsiella pneumoniae(CRKP)infection and the severity of acute pancreatitis.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 109 patients with acute pancreatitis who were admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2017 to January 2018 were collected.There were 66 males and 43 females,aged(48±17)years.Blood,body fluid or anal swab samples of patients were collected aseptically.Patients were treated with gallbladder puncture and drainage,nasobiliary drainage,surgical debridement,computed tomography(CT)guided interventional drainage or conservative treatment,respectively,after being comprehensively diagnosed.Observation indicators:(1)severity of acute pancreatitis and results of CRKP infection test;(2)diagnostic value of CRKP infection for severity of acute pancreatitis;(3)treatment of acute pancreatitis;(4)prognosis of patients.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test.Spearman correlation analysis were performed for correlation analyses.The receiver operating characteristic(ROC)curve was conducted to evaluate the diagnostic value.Results(1)Severity of acute pancreatitis and results of CRKP infection test:of 109 patients,there were 37 cases with mild acute pancreatitis,8 cases with moderate-severe acute pancreatitis,64 cases with severe acute pancreatitis.There were 45 cases with mild disease and 64 cases with severe disease,48 cases with CRKP infection and 61 cases without CRKP infection.There were 3 cases and 45 cases with CRKP infection in the 45 mild disease cases and 64 severe disease cases,respectively,showing a significant difference(χ2=43.430,P<0.05).Result of Pearson correlation analysis showed that CRKP infection was positively correlated with the severity of acute pancreatitis(r=0.631,P<0.05).The duration of hospital stay were(66±6)days and(24±3)days for the cases with CRKP infection and cases without CRKP infection,respectively,showing a significant difference(t=47.661,P<0.05).(2)Diagnostic value of CRKP infection for severity of acute pancreatitis:the area under the ROC curve,sensitivity,and specificity of CRKP infection for the diagnosis of SAP were 0.799(95%confidence interval as 0.714‒0.885,P<0.05),0.688,and 0.911,respectively.(3)Treatment of acute pancreatitis:of 109 patients,17 cases underwent nasobiliary drainage,19 cases underwent gallbladder puncture and drainage,42 cases underwent surgical debridement,48 cases underwent CT guided interventional drainage and 43 cases underwent conservative treatment.One patient may undergo multiple treatments.Of 109 patients,66 patients underwent one and more invasive treatments with 47 cases undergoing CRKP infection and 43 patients did not undergo invasive treatment with 1 case undergoing CRKP infection,respectively,showing a significant difference(χ2=50.134,P<0.05).(4)Prognosis of patients:all 109 patients were followed up for 3‒9 months,with a median follow-up time of 6 months.During the follow-up,there were 15 cases and 6 cases dead in the 48 cases with CRKP infection and the 61 cases without CRKP infection,respectively,showing a significant difference(χ2=7.919,P<0.05).Conclusion CRKP infec-tion is positively correlated with the severity of acute pancreatitis,and CRKP infection is associated with the duration of hospital stay and types of invasive treatments.