肺结核合并肺部感染患者病原菌分布及内毒素、钙结合蛋白检测的临床意义

Distribution of pathogenic bacteria in patients with pulmonary tuberculosis and pulmonary infection and the clinical significance of LSP and S100A9 detection

目的分析肺结核合并肺部感染患者病原菌分布及内毒素(LSP)、钙结合蛋白(S100A9)检测的临床意义。方法选取2017年1月至2020年6月我院收治肺结核患者216例,根据有无合并肺部感染分为感染组与未感染组。分析肺结核患者肺部感染及病原菌分布情况,对比感染组与未感染组LSP、S100A9蛋白、降钙素原、C反应蛋白水平,分析导致肺结核合并肺部感染的危险因素及LSP、S100A9蛋白检测对肺结核合并肺部感染的诊断价值。结果216例肺结核患者中99例合并肺部感染(感染组),117例未合并肺部感染(未感染组)。感染组患者痰液中共分离出124株病原菌,其中革兰阴性菌64株(51.61%),革兰阳性菌43株(34.68%),真菌17株(13.71%)。感染组LSP、S100A9、降钙素原、C反应蛋白水平高于未感染组(P<0.05)两组性别、年龄、病程比较差异无统计学意义(P>0.05);降钙素原、C反应蛋白、LSP、S100A9异常是导致肺结核合并肺部感染的独立危险因素(P<0.05);LSP、S100A9单独检测诊断肺结核合并肺部感染时ACU分别为0.791、0.712,LSP+S100A9诊断为0.832,LSP+S100A9诊断肺结核合并肺部感染诊断价值高于单独诊断(P<0.05)。结论肺结核合并肺部感染患者病原菌主要为革兰阴性菌,通过检测患者LSP、S100A9蛋白水平有利于肺部感染早期诊断,对评估疾病进展,治疗方案选择有重要参考价值。

Objective To analyze the distribution of pathogenic bacteria in patients with pulmonary tuberculosis and pulmonary infection and the clinical significance of detection of lipopolysaccharide(LSP)and calprotectin(S100A9).Methods We selected 216 patients with pulmonary tuberculosis admitted to our hospital from January 2017 to June 2020.According to whether the patients had pulmonary infection or not,they were divided into an infected group and a non-infected group.The pulmonary infection and the distribution of pathogenic bacteria in patients with pulmonary tuberculosis were analyzed.The levels of LSP,S100A9,procalcitonin(PCT),and C-reactive protein(CRP)were compared between the two groups.The risk factors leading to pulmonary infection were analyzed.The value of LSP and S100A9 detection in the diagnosis of pulmonary infection in patients was explored.Results Among the 216 patients,99 cases had pulmonary infection,and 117 had no pulmonary infection.We isolated 124 pathogenic bacteria from the sputum of the infected group.Of these,64 were gram-negative bacteria(51.61%),43 were gram-positive(34.68%),and 17 were fungi(13.71%).The levels of LSP,S100A9,PCT,and CRP in the infected group were higher than those in the non-infected group(P<0.05).There was no significant difference in gender,age,and disease course between the two groups(P>0.05).Abnormalities of PCT,CRP,LSP,and S100A9 were independent risk factors for pulmonary tuberculosis complicated with pulmonary infection(P<0.05).The AUC of ROC analysis for LSP and S100A9 in the diagnosis of pulmonary infection in the tuberculosis patients were 0.791 and 0.712,respectively.The AUC for LSP+S100A9 was 0.832,which was higher than that of single detection.The diagnostic value of LSP+S100A9 in the diagnosis of pulmonary tuberculosis complicated with pulmonary infection was higher than that of single diagnosis(P<0.05).Conclusion The pathogenic bacteria in tuberculosis patients with pulmonary infection are mainly gram-negative bacteria.The detection of LSP and S100A9 levels can lead to early diagnosis of pulmonary infection.The detection also has important reference value for assessing disease progression and choosing treatment options.