PCT、SAA及Treg因子检测在多重耐药菌感染抗菌治疗中的价值

The value of PCT,SAA and Treg factor assays in the antimicrobial treatment of multidrug⁃resistant bacterial infections

目的探讨血清降钙素原(PCT)、血淀粉样蛋白(SAA)及调节性T细胞(Treg)相关因子检测在多重耐药菌感染患者抗菌药物治疗中的指导价值。方法选取2022年1月至2023年7月海南医学院第一附属医院收治的多重耐药菌感染患者380例(试验组),另选取同期于本院行体检且各项正常健康者378名为对照组。比较两组血清PCT、SAA、转化生长因子⁃β(TGF⁃β)及白细胞介素A7A(ILA7A)水平;采用多元Logistic回归模型分析影响多重耐药菌感染的因素;分析试验组不同疗效患者治疗前、后血清PCT、SAA、TGF⁃β及ILA7A水平;分析PCT、SAA、TGF⁃β及ILA7A单独及联合检测对抗菌药物治疗疗效的评估价值。结果试验组血清PCT、SAA、ILA7A水平均高于对照组,TGF⁃β水平低于对照组,差异有统计学意义(P<0.05)。单因素回归分析显示,血清PCT、SAA、TGF⁃β及ILA7A水平是影响多重耐药菌感染的单因素,进一步行多元Logistic结果显示,血清PCT(>0.5μg/L)、SAA(>10 mg/L)、TGF⁃β降低及ILA7A升高均为影响多重耐药菌感染的危险因素(P<0.05)。有效组307例,无效组73例。治疗前两组血清PCT、SAA、TGF⁃β及ILA7A比较差异无统计学意义(P>0.05),治疗7 d后有效组PCT、SAA、ILA7A水平低于无效组,TGF⁃β水平高于有效组,差异有统计学意义(P<0.05)。ROC曲线显示,PCT、SAA、TGF⁃β及ILA7A四者联合检测评估抗菌药物治疗疗效的AUC为0.762,明显高于四者单一检测的AUC(P<0.05)。结论血清SAA、PCT、Treg细胞相关因子水平在多重耐药菌感染患者的抗菌药物治疗中均具有一定指导价值,且上述指标联合检测准确性最高,可为临床制定合理的治疗方案提供一定依据。

Objective To investigate the value of serum procalcitonin(PCT),blood amyloid(SAA)and regulatory T⁃cell(Treg)⁃associated factor assays in guiding antimicrobial drug therapy for patients with multidrug⁃resistant bacterial infections.Methods 380 cases of multidrug⁃resistant bacterial infections admitted to the First Affiliated Hospital of Hainan Medical College from January 2022 to July 2023 were selected(the test group),and 378 patients who underwent physical examinations in the hospital during the same period and were normal and healthy were selected as the control group.The study aimed to compare the serum PCT,SAA,transforming growth factor⁃β(TGF⁃β)and interleukin A7A(ILA7A)levels between the two groups,to analyze the single multifactorial factors affecting multidrug⁃resistant infections by using multivariate logistic regression model,and the serum PCT,SAA,TGF⁃βand ILA7A levels of the patients in the test group with different efficacies before and after the treatment.The levels of PCT,SAA,TGF⁃βand ILA7A individually and in parallel to assess the value of antibiotic treatment efficacy were analyzed.Results The serum PCT,SAA and ILA7A levels in the test group were higher than those in the control group,and the TGF⁃βlevel was lower than that in the control group,and the difference was statistically significant(P<0.05).Univariate regression analysis showed that serum PCT,SAA,TGF⁃βand ILA7A levels were single factors affecting multi⁃resistant infections,and further rows of multivariate logistic results showed that serum PCT(>0.5μg/L),SAA(>10 mg/L),reduced TGF⁃βand elevated ILA7A were risk factors affecting multi⁃resistant infections(P<0.05).There were 307 cases in the effective group and 73 cases in the ineffective group.There was no statistically significant difference in the comparison of serum PCT,SAA,TGF⁃βand ILA7A between the two groups before treatment(P>0.05),and the levels of PCT,SAA and ILA7A in the effective group were lower than those in the ineffective group,and the level of TGF⁃βwas higher than those in the effective group,with statistically significant differences after 7d of treatment(P<0.05).The ROC curve showed that the AUC of the four parallel assays of PCT,SAA,TGF⁃βand ILA7A for assessing the efficacy of antibiotic therapy was 0.762,which was significantly higher than that of the individual assays(P<0.05).Conclusion The levels of serum SAA,PCT,and Treg cell⁃associated factors play a significant role in guiding the antibiotic treatment of patients with multidrug⁃resistant infections.These indicators have the highest accuracy when tested in parallel,providing a certain basis for developing a reasonable treatment plan in clinical practice.