老年急性呼吸衰竭合并肺部感染患者病原菌分布特点、营养状况及血清炎症因子水平变化分析

Analysis on distribution characteristics of pathogens,nutritional status and changes of serum inflammatory factors in elderly patients with acute respiratory failure and pulmonary infection

目的 探讨老年急性呼吸衰竭合并肺部感染患者病原菌分布特点,营养状况,血清降钙素原(PCT)、白细胞介素-17(IL-17)水平变化及临床意义。方法 收集2017年6月至2021年6月大连大学附属中山医院收治的老年急性呼吸衰竭合并肺部感染70例(观察组),以及同期单纯肺部感染老年患者50例(对照组);两组患者入院后均进行微型营养评定简表(MNA-SF)评分用于筛查营养不良;检测血清PCT、IL-17水平,并利用ROC曲线评价PCT、IL-17以评估老年急性呼吸衰竭合并肺部感染患者预后的应用价值。结果 70例老年急性呼吸衰竭合并肺部感染患者共培养分离病原菌83株,其中革兰氏阳性菌20株(24.10%),革兰氏阴性菌62株(74.70%),真菌1株(1.20%)。两组病死率比较无显著差异(P>0.05),观察组MNA-SF评分、营养不良率显著高于对照组(P<0.05),血清PCT、IL-17水平显著高于对照组(P <0.05);老年急性呼吸衰竭合并肺部感染病死率14.29%(10/70),死亡患者血清PCT、IL-17水平均显著高于生存患者(P<0.05);血清PCT、IL-17联合评估老年急性呼吸衰竭合并肺部感染患者预后的AUC大于PCT单独评估的AUC(P <0.05),与IL-17单独评估的AUC比较无显著差异(P>0.05)。结论 老年急性呼吸衰竭合并肺部感染患者以革兰氏阴性菌感染为主,营养不良发生率高,血清PCT、IL-17水平明显上调,联合检测血清PCT、IL-17对其预后评估价值较高。

Objective To explore the distribution characteristics of pathogens,nutritional status,changes and clinical significance of serum procalcitonin(PCT)and interleukin-17(IL-17)levels in elderly patients with acute respiratory failure and pulmonary infection.Method A total of 70 elderly patients with acute respiratory failure and pulmonary infection admitted to Zhongshan Hospital Affiliated to Dalian University were enrolled as observation group between June 2017 and June 2021,while other 50 elderly patients only with pulmonary infection during the same period were enrolled as control group.After admission,all were scored by short-form mini-nutritional assessment(MNA-SF).The fasting venous blood was collected to detect serum PCT and IL-17.The application value of serum PCT and IL-17 in evaluating prognosis of elderly patients with acute respiratory failure and pulmonary infection was evaluated by ROC curves.Result In the 70 elderly patients with acute respiratory failure and pulmonary infection,there were 83 strains of pathogens,including 20 strains of Gram-positive bacteria(24.10%),62 strains of Gram-negative bacteria(74.70%)and 1 strain of fungus(1.20%).No significant difference was found in mortality rate between the two groups(P>0.05).MNA-SF score,malnutrition rate and serum PCT and IL-17 levels were significantly higher in observation group(P<0.05).The mortality rate in the elderly patients with acute respiratory failure and pulmonary infection was 14.29%(10/70).Serum PCT and IL-17 levels in dead patients were significantly higher than those in survived patients(P<0.05).AUC of serum PCT combined with IL-17 for assessing the prognosis was greater than that of PCT alone(P<0.05),and there was no significant difference between combined detection and IL-17 alone(P>0.05).Conclusion In elderly patients with acute respiratory failure and pulmonary infection,main pathogen is Gram-negative bacteria,incidence of malnutrition is higher,and levels of serum PCT and IL-17 significantly up-regulate.Combined detection of serum PCT and IL-17 is of good application value for prognosis assessment.