老年精神分裂症患者医院肺部感染病原菌及血清D-D、PCT、SACE变化和意义

Pathogens isolated from elderly schizophrenia patients with nosocomial pulmonary infection,changes of serum D-D,PCT,SACE and their significance

目的探究老年精神分裂症患者医院肺部感染病原菌分布特点及血清D-2聚体(D-D)、降钙素原(PCT)、血清血管紧张素转换酶(SACE)变化和意义。方法选择2019年3月-2020年12月天津市安定医院收治老年精神分裂症患者223例,按照是否并发医院肺部感染分为感染组37例和未感染组186例。收集两组患者一般资料,分析肺部感染危险因素。取感染组患者痰液标本进行病原菌培养和鉴定。收集两组患者晨起空腹外周血,检测血清D-D、PCT及SACE水平。结果合并内科疾病、口腔护理和排痰护理是导致感染风险增加的主要因素(P<0.05)。37例老年精神分裂症并发医院肺部感染患者呼吸道标本中共分离出46株病原菌,其中革兰阳性细菌13株,占28.26%,革兰阴性细菌31株,占67.39%,真菌2株,占4.35%。与未感染组相比,感染组患者血清D-D、PCT及SACE水平上调(P<0.05)。血清D-D水平>0.73μg/L、PCT水平>1.02 ng/ml、SACE>40.95 U/ml及三者联合时,预测老年精神分裂症患者医院肺部感染的曲线下面积(AUC)分别为0.838、0.789、0.850、0.900,三者联合检测的预测效能最高(P<0.05)。结论老年精神分裂症患者易受革兰阴性细菌入侵引发肺部感染,感染患者早期血清D-D、PCT及SACE水平明显升高,这三个血清学指标的联合检测可预测老年精神分裂症患者肺部感染。

OBJECTIVE To explore the distribution of pathogens isolated from elderly schizophrenia patients with nosocomial pulmonary infection,observe the changes of serum D-2 dimer(D-D),procalcitonin(PCT)and serum angiotensin converting enzyme(SACE),and analyze their significance.METHODS A total of 223 elderly patients with schizophrenia who were treated in Tianjin Anding Hospital from Mar 2019 to Dec 2020 were enrolled in the study and were divided into the infection group with 37 cases and the no infection group with 186 cases according to the status of nosocomial pulmonary infection.The baseline data were collected from the two groups of patients,the risk factors for the pulmonary infection were analyzed,the sputum specimens were collected from the patients of the infection group so as to carry out the culture of pathogens,the isolated pathogens were identified,the fasting peripheral blood specimens were collected from the two groups of patients in the morning,and the levels of serum D-D,PCT and SACE were detected.RESULTS Complication with internal medicine diseases,oral care and expectoration care were the major factors leading to the increase of risk of the infection(P<o.05).Totally 46 strains of pathogens were isolated from the 37 elderly schizophrenia patients complicated with nosocomial pulmonary infection,13(28.26%)of which were gram-positive bacteria,31(67.39%)were gram-negative bacteria,and 2(4.35%)were fungi.The levels of serum D-D,PCT and SACE of the infection group were significantly higher than those of the no infection group(P<0.05).The areas under curves(AUCs)of the serum D-D more than 0.73μg/L,PCT more than 1.02 ng/ml,SACE more than 40.95 U/ml and the joint detection of the three indexes were respectively 0.838,0.789,0.850 and 0.900 in prediction of nosocomial pulmonary infection in the elderly patients with schizophrenia,and the joint detection of the three indexes had the highest prediction efficiency(P<0.05).CONCLUSION The elderly patients with schizophrenia are vulnerable to be infected with gram-negative bacteria,which may cause the pulmonary infection,the patients with the infection show remarkable rise of serum D-D,PCT and SACE in early stage.The joint detection of the three serologic indexes can predict the nosocomial pulmonary infection in the elderly patients with schizophrenia.