风湿性心脏病合并细菌性心内膜炎病原学及其炎性因子对预后的预测价值

Predictive value of detected pathogenic bacteria and their inflammatory factors for the prognosis of rheumatic heart disease combined with bacterial endocarditis

目的探讨风湿性心脏病合并细菌性心内膜炎检出病原菌及其炎性因子对预后的预测价值.方法选取2019年1月-2021年1月南阳医学高等专科学校第一附属医院分析确诊为风湿性心脏病合并细菌性心内膜炎患者85例为研究对象,根据预后情况分为不良预后组(36例)和无并发症组(49例),分析患者检出病原菌及淋巴细胞(LY)、白细胞计数(WBC)、中性粒细胞(NEUT)的数量以及红细胞沉降率(ESR)和降钙素原(PCT)、C-反应蛋白(CRP)检测,采用受试者工作特征(ROC)曲线评估各炎症因子对预后的预测价值.结果85份血培养标本中,病原学检测阳性70.59%,检出病原菌207株,其中革兰阴性菌60株占28.99%,革兰阳性菌147株占71.01%;血培养阳性患者的WBC、LY、NEUT、ESR高于血培养阴性患者(P<0.05);不良预后组患者PCT、CRP高于无并发症组(P<0.05);随访3个月,PCT低表达患者有52例,平均生存时间为(2.56±0.09)个月,高表达患者33例,平均生存时间为(1.09±0.11)个月,两组的Logrank分析卡方值为29.476(P<0.001);CRP低表达58例,平均生存时间为(2.49±0.13)个月,高表达患者27例,平均生存时间为(1.07±0.12)个月,两组的Logrank分析卡方值为25.976(P<0.001);Logistic多元回归分析结果显示,手术治疗是影响风湿性心脏病合并细菌性心内膜炎患者预后的危险因素(P<0.05);PCT与CRP及联合诊断风湿性心脏病合并细菌性心内膜炎预后的AUC分别为0.922、0.997和0.999.结论革兰阳性菌为风湿性心脏病合并细菌性心内膜炎的主要病原菌,且以链球菌最为常见,血培养阳性患者的WBC、LY、NEUT、ESR高于血培养阴性患者,不良预后组患者血清中的CRP及PCT均明显较无并发症组的患者高,且PCT和CRP联合诊断预后的准确性均较高,可作为风湿性心脏病合并细菌性心内膜炎不良预后诊断的生物学指标.

OBJECTIVE To investigate the predictive value of detected pathogenic bacteria and their inflammatory factors for the prognosis of rheumatic heart disease combined with bacterial endocarditis.METHODS Totally 85 patients diagnosed with rheumatic heart disease and bacterial endocarditis in the First Affiliated Hospital of Nan-yang Medical College from Jan.2019 to Jan.2021 were selected as the study subjects,and were divided into a poor prognosis group(36 cases)and a no-complication group(49 cases)according to their prognosis.The detected pathogenic bacteria,and lymphocyte(LY),white blood cell count(WBC),the number of neutrophils(NEUT),as well as erythrocyte sedimentation rate(ESR),procalcitonin(PCT),and C-reactive protein(CRP)of patients were analyzed,and the predictive value of individual inflammatory factors for prognosis was evaluated using the receiver operating characteristic(ROC)curve.RESULTS Among the 85 blood culture specimens,70.59%were positive for pathogenicity,and 207 strains of pathogenic bacteria were detected,of which 60 strains of Gram-nega-tive bacteria accounted for 28.99%,and 147 strains of Gram-positive bacteria accounted for 71.01%.The WBC,LY,NEUT,and ESR of patients with blood culture-positive were higher than those of patients with blood cul-ture-negative(P<0.05).The PCT and CRP levels in patients in the poor prognosis group were higher than those in patients in the no-complication group(P<0.05).Following up for 3 months,there were 52 patients with low expression of PCT,with an average survival time of(2.56±0.09)months.There were 33 patients with high ex-pression,with an average survival time of(1.09±0.11)months.The chi square value of Logrank analysis for the two groups was 29.476(P<0.001).There were 58 cases with low CRP expression,with an average survival time of(2.49±0.13)months.There were 27 cases with high CRP expression,with an average survival time of(1.07±0.12)months.The chi square value of Logrank analysis for two groups was 25.976(P<0.001).The results of lo-gistic multiple regression analysis showed that surgical treatment was a risk factor affecting the prognosis of pa-tients with rheumatic heart disease combined with bacterial endocarditis(P<0.05).The AUC of PCT,CRP,and combined diagnosis for the prognosis of rheumatic heart disease combined with bacterial endocarditis were 0.922,0.997,and 0.999,respectively.CONCLUSION Gram-positive bacteria were the main pathogenic bacteria of rheu-matic heart disease combined with bacterial endocarditis,and Streptococcus were the most common.WBC,LY,NEUT,ESR of blood culture-positive patients were higher than those of blood culture-negative patients.The ser-um CRP and PCT of patients in the poor prognosis group were significantly higher than those of patients in the no-complication groups,and the accuracy of combined diagnosis of PCT and CRP was higher,which could be used as a biological indicator for the diagnosis of poor prognosis of rheumatic heart disease combined with bacterial endocarditis.