急诊内科脓毒症患者的炎症因子表达、病原菌分布及其预后分析

Expression of inflammatory factor,pathogenic bacteria distribution,and prognostic analysis in patients with sepsis in Emergency Department of Internal Medicine

目的观察急诊内科脓毒症患者的炎症因子表达水平和病原菌分布特点,并分析炎症因子对患者预后的预测价值。方法选取2019年1月至2021年1月西安市第四医院急诊内科收治的126例脓毒症感染患者作为研究对象(脓毒症感染组),同时选取90例健康志愿者作为对照组。采集脓毒症感染组患者和对照组受检者的血液样本,检测、比较脓毒症组和对照组受检者的降钙素原(PCT)、C反应蛋白(CRP)、白介素-6(IL-6)和内毒素水平。根据脓毒症组患者治疗后6个月的预后情况将其分为存活组和死亡组,比较不同预后情况患者的炎症因子表达水平,并建立受试者工作曲线(ROC)以评价各炎症因子对患者预后的预测价值。结果126例患者中30例为革兰阳性菌感染(23.81%),96例为革兰阴性菌感染(76.19%);126例患者的血样培养中共分离出148株菌株,其中革兰阳性菌35株(23.65%),前三种菌株为葡萄球菌属16株(10.81%)、链球菌属9株(6.08%)、肠球菌属8株(5.41%);革兰阴性菌113株(76.35%),前三种菌株为鲍曼不动杆菌25株(16.89%)、肺炎克雷伯菌22株(14.86%)、大肠埃希菌18株(12.16%);脓毒症组患者的PCT、CRP、IL-6和内毒素表达水平明显高于对照组,差异均有统计学意义(P<0.05);死亡组患者的PCT、CRP、IL-6和内毒素表达水平明显高于生存组,差异均有统计学意义(P<0.05);以死亡组患者为参照,脓毒症感染患者PCT、CRP、IL-6、内毒素预测脓毒症感染死亡的最佳截断值为1.435 ng/mL、90.625 mg/mL、20.585 pg/mL、0.9950 ng/mL。结论脓毒症患者的血液PCT、CRP、IL-6和内毒素水平均存在显著异常,且PCT、CRP、IL-6和内毒素水平均可在一定程度上反映和预测患者的病情和预后情况。临床实践中应及时对脓毒症患者及时展开炎症因子监测,以针对病情发展变化及时进行治疗干预。

Objective To observe and study the expression of inflammatory factors and the distribution of pathogenic bacteria in patients with sepsis in Emergency Department of Internal Medicine,and further analyze its prog-nostic value.Methods A total of 126 patients with sepsis treated in Emergency Department of Internal Medicine,Xi'an Fourth Hospital from January 2019 to January 2021 were selected as the research objects(sepsis group),and 90 healthy volunteers were selected as the control group.Blood samples were collected from patients in sepsis group and subjects in control group.The levels of procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6),and endotoxin of pa-tients in sepsis group and control group were detected and compared.The patients in the sepsis group were divided into survival group and death group according to the prognosis of 6 months after treatment.The expression of inflammatory factors in patients with different prognosis were compared.Receiver operating curve(ROC)were established to evalu-ate the prognostic value of each inflammatory factor.Results Among the 126 patients,there were 30 patients infected by Gram-positive bacteria(23.81%)and 96 patients infected by Gram-negative bacteria(76.19%).A total of 148 strains were isolated from the blood samples of 126 patients,of which 35 were Gram-positive bacteria(23.65%),mainly Staphy-lococcus(16 strains,10.81%),Streptococcus(9 strains,6.08%),and Enterococcus(8 strains,5.41%),and 113 were Gram-negative bacteria(76.35%),mainly Acinetobacter baumannii(25 strains,16.89%),Klebsiella pneumoniae(22 strains,14.86%),and Escherichia coli(18 strains,12.16%).The expression levels of PCT,CRP,IL-6,and endotoxin in the sepsis group were significantly higher than those in the control group(P<0.05).The expression levels of PCT,CRP,IL-6,and endotoxin in the death group were significantly higher than those in the survival group(P<0.05).With the death group as the reference,the optimal cutoff values of PCT,CRP,IL-6,and endotoxin in patients with sepsis for pre-dicting the death were 1.435 ng/mL,90.625 mg/mL,20.585 pg/mL,and 0.9950 ng/mL,respectively.Conclusion Pa-tients with sepsis have significant abnormalities in blood PCT,CRP,IL-6,and endotoxin levels,and the levels of the four indexes can reflect and predict the patient's condition and prognosis to a certain extent.In clinical practice,the moni-toring of inflammatory factors should be carried out in time for patients with sepsis in order to provide timely treatment and intervention in response to the development and changes of the disease.