老年心力衰竭合并肺部感染病原菌分布及血清CRP、PCT水平变化

Distribution of pathogenic bacteria and changes of serum CRP and PCT levels in elderly patients with heart failure and pulmonary infection

目的了解老年心力衰竭合并肺部感染患者病原菌分布及血清C反应蛋白(CRP)、降钙素原(PCT)水平变化。方法本研究选取2019年7月~2022年7月在本院就诊的老年心力衰竭合并肺部感染患者64例作为感染组,选取同期单纯老年心力衰竭未合并肺部感染患者64例作为未感染组,另选取同期健康体检者64例作为对照组。使用全自动微生物鉴定系统对病原菌分布进行检测;采用免疫比浊法检测CRP;采用循环增强荧光免疫发光法检测PCT;采用Logistic回归分析老年心力衰竭合并肺部感染的影响因素;受试者工作特征(ROC)曲线分析血清CRP、PCT对老年心力衰竭合并肺部感染的诊断价值。结果感染组64例患者共分离出102株致病菌,主要以革兰阴性菌(72株)为主,其主要包括肺炎克雷伯菌(28株)、铜绿假单胞菌(16株)和大肠埃希菌(132株)。感染组和未感染组PaO2和LVEF显著低于对照组(P<0.05),PaCO_(2)、BNP、LVEDD、LVESD和CRP、PCT显著高于对照组(P<0.05)。感染组PaO2和LVEF显著低于未感染组(P<0.05),PaCO_(2)、BNP、LVEDD、LVESD和CRP、PCT显著高于未感染组(P<0.05)。Logistic回归分析结果显示,CRP和PCT高水平是影响老年心力衰竭合并肺部感染的危险因素(P<0.05)。ROC曲线结果显示,CRP诊断老年心力衰竭合并肺部感染的曲线下面积(AUC)为0.906,PCT诊断老年心力衰竭合并肺部感染的AUC为0.867,二者联合诊断老年心力衰竭合并肺部感染的AUC为0.945,二者联合的AUC优于各自单独诊断(Z联合vs CRP=2.504,Z联合vs PCT=2.724,P均<0.05)。结论老年心力衰竭合并肺部感染患者病原菌分布主要以革兰阴性菌为主,血清CRP、PCT水平显著升高,二者联合对老年心力衰竭合并肺部感染有良好的诊断价值。

Objective To understand the distribution of pathogenic bacteria and changes in serum C-reactive protein(CRP)and procalcitonin(PCT)levels in elderly patients with heart failure and lung infection.Methods In this study,64 elderly patients with heart failure complicated with lung infection who visited our hospital in July 2019-July 2022 were selected as the infection group,64 patients with simple elderly heart failure without lung infection were selected as the uninfected group,and 64 healthy patients were selected as the control group.Detection of pathogenic bacteria distribution using a fully automated microbial identification system;Immunoturbidimetry was used to detect CRP;PCT was detected by enhanced fluorescence immunoluminescence.Logistic regression was used to analyze the influencing factors of heart failure combined with lung infection in the elderly.The receiver operating characteristics(ROC)curve analyzed the diagnostic value of serum CRP and PCT in elderly heart failure complicated with lung infection.Results A total of 102 pathogenic bacteria were isolated from 64 patients in the infection group,mainly gram-negative bacteria(72 strains),mainly including Klebsiella pneumoniae(28 strains),Pseudomonas aeruginosa(16 strains)and Escherichia coli(132 strains).PaO_2 and LVEF were significantly lower than those in the control group(P<0.05),and PaCO_2,BNP,LVEDD,LVESD and CRP,and PCT were significantly higher than those in the control group(P<0.05).PaO_(2) and LVEF were significantly lower in the infected group than those in the uninfected group(P<0.05),and PaCO_(2),BNP,LVEDD,LVESD and CRP,and PCT were significantly higher than those in the uninfected group(P<0.05).The results of logistic regression analysis showed that high levels of CRP and PCT were risk factors affecting heart failure and pulmonary infection in elderly people(P<0.05).The ROC curve results showed that the area under the curve(AUC)under the curve(AUC)for CRP diagnosis of elderly heart failure complicated with lung infection was 0.906,the AUC of PCT for the diagnosis of elderly heart failure combined with lung infection was 0.867,and the AUC of the two combined diagnosis of elderly heart failure combined with lung infection was 0.945,and the AUC of the two combination was better than that of each individual diagnosis(Z_(combined vs CRP)=2.504,Z_(combined vs PCS)=2.724,P<0.05).Conclusion The distribution of pathogenic bacteria in elderly patients with heart failure complicated by lung infection was mainly gram-negative bacteria,and serum CRP and PCT levels were significantly increased,and the combination of the two had good diagnostic value for elderly heart failure combined with lung infection.