血清NGAL、BNP水平在多重耐药菌血流感染早期诊断中的价值分析

Analysis of the value of serum NGAL and BNP levels in the early diagnosis of multi-drug resistant bacteria bloodstream infection

目的探究血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、脑钠肽(BNP)对多重耐药菌血流感染(BSI)的早期诊断价值。方法选取2017年5月—2021年4月赤峰市医院收治多重耐药菌感染患者480例进行血培养,并鉴别细菌类型,按血培养结果分为血培养阴性组(n=379)、血培养阳性组(n=101),比较2组患者一般资料,酶联免疫吸附法检测血清NGAL、BNP水平;比较不同血培养结果和不同细菌感染类型BSI患者血清NGAL、BNP水平;利用受试者工作特征曲线评价血清NGAL、BNP对多重耐药菌BSI、多重耐药革兰阴性(G^(-))菌BSI的诊断价值。结果多重耐药菌感染患者480例中血培养阳性101例(21.04%),革兰阳性(G^(+))菌感染者41例(40.59%,G^(+)亚组),G^(-)菌感染60例(59.41%,G^(-)亚组);血培养阳性组患者置入尿管、深静脉置管患者占比及血清NGAL、BNP水平高于血培养阴性组(χ^(2)/t/P=5.032/0.025、13.582/0.000、26.592/0.000、23.216/0.000);G^(+)亚组患者血清NGAL、BNP水平低于G^(-)亚组(t/P=6.987/0.000、8.170/0.000)。血清NGAL、BNP诊断多重耐药菌BSI的曲线下面积(AUC)分别为0.852、0.866,二者联合的AUC为0.931,优于单独诊断(Z/P=2.820/0.005、2.129/0.033)。血清NGAL、BNP诊断多重耐药G^(-)菌BSI的AUC分别为0.887、0.660,二者联合的AUC为0.893,优于BNP单独诊断(Z/P=3.742/0.000),但与NGAL单独诊断差异无统计学意义(Z/P=0.135/0.893)。结论多重耐药菌BSI患者血清NGAL、BNP水平较高,并在多重耐药G^(-)菌BSI患者中更为显著,二者联合可更好地诊断多重耐药菌BSI和辅助鉴别细菌类型,测定血清NGAL、BNP水平有利于指导临床早期合理用药。

Objective To explore the early diagnosis value of serum neutrophil gelatinase^(-)associated lipocalin(NGAL)and brain natriuretic peptide(BNP)for multi^(-)drug resistant bacteria bloodstream infection(BSI).Methods From May 2017 to April 2021,480 patients with multi^(-)drug resistant bacteria infection were selected for blood culture,and the types of bacteria were identified.According to the blood culture results,they were divided into blood culture negative group and blood culture positive group.Comparing the general data of the two groups of patients,enzyme^(-)linked immunosorbent assay was used to detect serum NGAL and BNP levels.Compare the results of different blood cultures and the serum NGAL and BNP levels of BSI patients with different types of bacterial infections.The receiver operating characteristic curve was used to evaluate the diagnostic value of serum NGAL and BNP for BSI of multidrug^(-)resistant bacteria and BSI of multidrug^(-)resistant gram^(-)negative G bacteria.Results Among the 480 patients with multi^(-)drug^(-)resistant bacteria infection,101 were blood culture positive(21.04%),41 were Gram^(-)positive(G^(+))infection(40.59%,G^(+)subgroup),and 60 were G bacteria(59.41%,G subgroup).Group.The proportion of patients with urethral catheterization and deep venous catheterization in the blood culture^(-)positive group and the serum NGAL and BNP levels were higher than those in the blood culture^(-)negative group(χ^(2)/t/P=5.032/0.025,13.582/0.000,26.592/0.000,23.216/0.000).The serum NGAL and BNP levels of patients in the G^(+)subgroup were lower than those in the G subgroup(t/P=6.987/0.000,8.170/0.000).The area under the curve(AUC)of serum NGAL and BNP in the diagnosis of multi^(-)drug resistant bacteria BSI were 0.852 and 0.866,respectively.The combined AUC of the two was 0.931,which was better than the single diagnosis(Z/P=2.820/0.005,2.129/0.033).The AUCs of serum NGAL and BNP for the diagnosis of multi^(-)drug resistant G bacteria BSI were 0.887 and 0.660,respectively.The combined AUC of the two was 0.893,which was better than that of BNP alone(Z/P=3.742/0.000),but it was different from NGAL alone.No statistical significance(Z/P=0.135/0.893).Conclusion The levels of serum NGAL and BNP in patients with multi^(-)drug^(-)resistant BSI are higher,and they are more significant in patients with multi^(-)drug^(-)resistant G^(-)bacteria BSI.The combination of the two can better diagnose multi^(-)drug resistant BSI and assist in the identification of bacterial types,and determine serum NGAL,BNP level is conducive to guiding the rational use of drugs in the early clinical stage.