住院患者肺部感染的病原菌分布及炎症因子水平分析

Distribution of pathogenic bacteria and levels of inflammatory factors in hospitalized patients with pulmonary infection

目的分析住院患者肺部感染的病原菌分布及炎症因子水平分析。方法随机抽取2016年1月到2021年4月惠州市中心人民医院发生肺部感染的住院患者516例,根据患者入科24h内急性生理与慢性健康状况评分(APACHEⅡ)情况,将其分为低危组(APACHEⅡ评分<10分,194例),中危组(10≤APACHEⅡ评分≤20分,227例)和高危组(APACHEⅡ评分>20分,95例),另外选取同期收治的未发生肺部感染的住院患者患者200例为对照组,采用全自动微生物分析仪对观察组患者的痰液标本进行病原菌的培养鉴定,采用ELISA检测两组降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)水平。结果肺部感染患者中共检出643株病原菌,其中革兰氏阳性菌共169株(26.28%),主要是金黄色葡萄球菌93株(14.46%)、肺炎链球菌57株(8.86%);革兰氏阴性菌共429株(66.72%),主要是以鲍曼不动杆菌187株(29.08%)、肺炎克雷伯菌163株(25.35)为主;真菌共45株(7.00%);实验组血清PCT、TNF-α、hs-CRP水平显著高于对照组(t_(1)=27.167,t_(2)=6.419,t_(3)=34.591,P<0.05);高危组患者血清PCT、TNF-α、hs-CRP水平显著高于中危组和低危组(P<0.05);中危组血清PCT、TNF-α、hs-CRP水平显著高于低危组(P<0.05);经Pearson相关性分析,结果表明PCT、TNF-α、hs-CRP与住院患者肺部感染病情严重程度均呈明显正相关,相关系数分别为(r=0.725,0.617,0.679,P<0.05)。结论住院患者发生肺部感染时主要是的病原菌是鲍曼不动杆菌、肺炎克雷伯菌和金黄色葡萄球菌,肺部感染患者炎症因子水平明显升高,可用于评估患者病情严重程度。

Objective To analyze the distribution of pathogenic bacteria and the level of inflammatory factors in hospitalized patients with pulmonary infection.Methods A total of 516 inpatients with pulmonary infection in our hospital from January 2016 to April 2021 were randomly selected.According to the acute physiological and chronic health status score(APACHE Ⅱ)within 24 hours after admission,they were divided into low-risk group(APACHE Ⅱ score<10,194 cases),medium-risk group(10≤APACHE Ⅱ≤20 points,227 cases)and high-risk group(APACHE Ⅱ>20 points,95 cases).In addition,200 inpatients without pulmonary infection in the same period were selected as the control group.The sputum specimens of the observation group were cultured and identified by automatic microbial analyzer.The levels of procalcitonin(PCT),tumor necrosis factor-α(TNF-α)and hypersensitive C-reactive protein(hs-CRP)in the two groups were detected by ELISA.Results A total of 643 strains of pathogenic bacteria were detected in patients with pulmonary infection,among which 169 strains(26.28%)were gram-positive bacteria,mainly 93 strains(14.46%)of Staphylococcus aureus,57 strains(8.86%)of streptococcus pneumoniae.There were 429 strains(66.72%)of gram-negative bacteria,mainly 187 strains(29.08%)of Acinetobacter baumannii and 163 strains(25.35)of Klebsiella pneumoniae.There were 45 strains of fungi(7.00%).Serum PCT,TNF-αand hs-CRP levels in experimental group were significantly higher than those in control group(t_(1)=27.167,t_(2)=6.419,t_(3)=34.591,P<0.05).The serum levels of PCT,TNF-αand hs-CRP in high-risk group were significantly higher than those in medium-risk and low-risk groups(P<0.05);Serum PCT,TNF-αand hs-CRP levels in medium-risk group were significantly higher than those in low-risk group(P<0.05);Pearson correlation analysis showed that PCT,TNF-αand hs-CRP were significantly positively correlated with the severity of pulmonary infection in hospitalized patients(r=0.725,0.617,0.679,P<0.05).Conclusion Acinetobacter baumannii,Klebsiella pneumoniae and Staphylococcus aureus were the main pathogenic bacteria in hospitalized patients with pulmonary infection.The levels of inflammatory factors in patients with pulmonary infection were significantly increased,which could be used to assess the severity of the patient′s disease.