慢性阻塞性肺疾病急性加重合并呼吸机相关性肺炎患者病原菌分布及血清指标水平变化

Distribution of pathogenic bacteria and changes of serum index levels in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with ventilator-associated pneumonia

目的探讨慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸机相关性肺炎(VAP)患者病原菌分布及血清可溶性髓系细胞触发受体-1(sTREM-1)、C反应蛋白(CRP)、白细胞介素35(IL-35)的水平变化情况。方法将102例AECOPD合并VAP患者作为观察组,同期确诊治疗的102例AECOPD患者作为对照组,分析观察组病原菌分布情况,比较两组血清sTREM-1、CRP、IL-35水平及危重患者肺部感染指数(CPIS)评分变化情况,分析sTREM-1、CRP、IL-35水平与CPIS评分的关系及三项指标预测AECOPD患者合并VAP的效能。结果观察组标本共分离出119株病原菌,其中革兰阳性菌占42.86%,以金黄色葡萄球菌和表皮葡萄球菌为主,革兰阴性菌占55.46%,以大肠埃希菌和鲍曼不动杆菌为主,真菌占1.68%;观察组血清sTREM-1、CRP、IL-35水平及CPIS评分高于对照组(P<0.05);AECOPD合并VAP患者CPIS评分与血清sTREM-1、CRP、IL-35呈正相关(P<0.05);血清sTREM-1、CRP、IL-35预测AECOPD合并VAP的ROC曲线下面积(AUC)分别为0.742、0.505、0.735,其中血清sTREM-1、IL-35的AUC较大,其预测AECOPD合并VAP的敏感度分别为90.20%、62.75%。结论AECOPD合并VAP患者的病原菌主要为革兰阴性菌,患者的血清sTREM-1、CRP、IL-35水平随病情严重程度升高,可为病情评估预测及诊断提供指导。

Objective To explore the distribution of pathogenic bacteria and the changes of levels of serum soluble triggering receptor expressed on myeloid cells-1(sTREM-1),C-reactive protein(CRP)and interleukin 35(IL-35)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with ventilator-associated pneumonia(VAP).Methods One hundred and two patients with AECOPD combined with VAP were classified as an observation group,and another 102 patients with AECOPD diagnosed and treated during the same period were enrolled as a control group.The distribution status of pathogenic bacteria was analyzed in the observation group,and the changes of levels of serum sTREM-1,CRP and IL-35 and clinical pulmonary infection score(CPIS)of critically ill patients were compared between the two groups.The relationship between the levels of sTREM-1,CRP and IL-35 and the CPIS was analyzed.The efficiency of the three indicators in predicting the VAP in patients with AECOPD was evaluated.Results A total of 119 strains of pathogenic bacteria were isolated from the specimens of patients in the observation group.Among the stains,Gram-positive bacteria accounted for 42.86%mainly Staphylococcus aureus and Staphylococcus epidermidis,Gram-negative bacteria accounted for 55.46%mainly Escherichia coli and Acinetobacter baumannii and fungi accounted for 1.68%.The levels of serum sTREM-1,CRP and IL-35 and CPIS score in the observation group were higher than those in the control group(P<0.05).The CPIS score of patients with AECOPD and VAP was positively correlated with serum sTREM-1,CRP and IL-35(P<0.05).The areas under the ROC curve(AUC)of serum sTREM-1,CRP and IL-35 in predicting AECOPD with VAP were 0.742,0.505 and 0.735,respectively,of which the AUC values of serum sTREM-1 and IL-35 were larger and their sensitivities for predicting AECOPD with VAP were 90.20%and 62.75%,respectively.Conclusion The pathogenic bacteria in patients with AECOPD and VAP are mainly Gram-negative bacteria.The levels of serum sTREM-1,CRP and IL-35 of patients are increased with the disease severity.These can provide guidance for disease evaluation,prediction,and diagnosis.