非小细胞肺癌患者下呼吸道感染病原菌分布及其易感因素回归方程构建

Distribution of pathogens isolated from non-small cell lung cancer patients with lower respiratory tract infection and regression equation established based on susceptible factors

目的分析非小细胞肺癌患者下呼吸道感染病原菌分布,并构建易感因素回归方程.方法回顾性收集2020年5月-2022年5月南阳医学高等专科学校第一附属医院收治的249例非小细胞肺癌患者临床资料,根据患者是否发生下呼吸道感染分为感染组52例和未感染组197例.分析感染病原菌分布,单因素及多因素Logis-tic回归分析下呼吸道感染的易感因素,并构建回归方程,采用受试者工作特征(ROC)曲线分析回归方程预测呼吸道感染的临床价值.结果下呼吸道感染患者共分离74株病原菌,其中革兰阴性菌47株,占63.51%;多因素Logistic回归分析结果显示,合并糖尿病、合并营养不良、临床病理(TNM)分期Ⅲ~Ⅳ期、CD_(4)^(+)/CD_(8)^(+)<1.33均为非小细胞肺癌患者下呼吸道感染的易感因素(P<0.05),预防性使用抗菌药物是非小细胞肺癌患者下呼吸道感染的保护因素(P<0.05);将上述因素纳入回归方程:Logit(P)=-1.526+合并糖尿病×1.002+合并营养不良×0.893+TNM分期×1.392-预防性使用抗菌药物×0.603+CD_(4)^(+)/CD_(8)^(+)×0.895,ROC曲线结果显示,当Logit(P)>10.64时,曲线下面积(AUC)值为0.838,敏感度为88.46%,特异度为65.99%.结论非小细胞肺癌下呼吸道感染患者主要感染病原菌为革兰阴性菌,其易感因素包括合并糖尿病、合并营养不良、TNM分期、CD_(4)^(+)/CD_(8)^(+)水平,保护因素为预防性使用抗菌药物,据此构建的回归方程对非小细胞肺癌患者下呼吸道感染具有较好的预测价值.

OBJECTIVE To observe the distribution of pathogens isolated from the non-small cell lung cancer(NSCLC)patients with lower respiratory tract infection and establish the regression equation based on susceptible factors.METHODS The clinical data were retrospectively collected from 249 NSCLC patients who were treated in the First Affiliated Hospital of Nanyang Medical College from Feb 2020 to Feb 2022.The enrolled patients were divided into the infection group with 52 cases and the no infection group with 197 cases according to the status of lower respiratory tract infection.The distribution of pathogens causing the infection was analyzed,univariate analysis and multivariate logistic regression analysis were performed for the susceptible factors for the lower respiratory tract infection,the regression equation was established,and the clinical value of the regression equation in prediction of respiratory tract infection was analyzed by means of receiver operating characteristic(ROC)curve.RESULTS Totally 74 strains of pathogens were isolated from the patients with lower respiratory tract infection,47(63.51%)of which were gram-negative bacteria.The result of multivariate logistic regression analysis showed that complication with diabetes mellitus,complication with malnutrition,tumor-node-metastasis(TNM)stage ofⅢ~Ⅳand CD_(4)^(+)/CD_(8)^(+)less than 1.33 were the susceptible factors for the lower respiratory tract infection in the NSCLC patients(P<0.05),and the prophylactic use of antibiotics was the protective factor for the lower respiratory tract infection in the NSCLC patients(P<0.05);the above factors were brought into the equation regression:Logit(P)=-1.526+complication with diabetes mellitus×1.002+complication with malnutrition×0.893+TNM stage×1.392-prophylactic use of antibiotics×0.603+CD_(4)^(+)/CD_(8)^(+)×0.895.The result of ROC curve analysis indicated that when Logit(P)was more than 10.64,the area under curve(AUC)was 0.838,with the sensitivity 88.46%,the specificity 65.99%.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the NSCLC patients with lower respiratory tract infection.The susceptible factors include the complication with diabetes mellitus,complication with malnutrition,TNM stage and CD_(4)^(+)/CD_(8)^(+)level,the prophylactic use of antibiotics is the protective factor.The regression equation established based on the above factors has high value in prediction of lower respiratory tract infection in the NSCLC patients.