感染源对脓毒症病理生理及预后影响的临床研究

Clinical study on the influence of source of infection on the pathophysiology and prognosis of sepsis

目的探讨脓毒症患者不同感染部位引起病理生理反应的异同,并评估感染源对患者预后的临床意义。方法选取佛山市中医院2021年1月1日至2023年1月1日159例有明确感染源的脓毒症患者,根据28d内的生存情况,分为存活组(98例)及死亡组(61例)。采用多因素Logistic回归分析探讨影响脓毒症患者预后的独立危险因素。根据感染源进行分组,对比不同感染源组患者28d内病死率,并通过方差分析探讨血浆生物标志物在不同感染源组中的分布差异。结果159例患者中,感染源分布频次从高到低依次为呼吸道(62.89%)、尿路(13.84%)、腹腔(13.21%)、皮肤及软组织(10.06%);多因素Logistic回归分析显示,年龄、降钙素原、脓毒症相关性器官功能衰竭评价评分和呼吸道感染源是影响脓毒症患者28d内死亡的显著危险因素(P<0.05);不同感染源组在炎症、凝血及器官功能障碍方面表现出不同程度的差异,具有异质性。结论感染源的差异导致脓毒症在病理生理特点(炎症反应、凝血激活和器官功能障碍)及短期预后(28d内病死率)上的显著差异。

Objective To investigate the similarities and differences in the pathophysiological responses caused by different infection sites in sepsis patients and to evaluate the clinical significance of the source of infection on the prognosis of patients.Methods A total of 159 patients with a clear source of infection in Foshan Hospital of Traditional Chinese Medicine from January 1,2021 to January 1,2023 were selected and divided into survival group(n=98)and death group(n=61)based on their survival status within 28 days.The independent risk factors affecting the prognosis of sepsis patients were determined by multivariate Logistic regression analysis.The 28-day mortality rates of different infection source groups were compared,and the distribution differences of serum biomarkers in different infection source groups were explored by analysis of variance.Results Among the 159 patients,the frequency of infection source distribution was as follows in descending order:Respiratory tract(62.89%),urinary tract(13.84%),abdomen(13.21%),skin and soft tissue(10.06%).Multivariate Logistic regression analysis showed that age,procalcitonin,sepsis-related organ failure assessment score,and respiratory tract infection source were significant risk factors affecting the 28-day mortality of sepsis patients(P<0.05).Different infection source groups showed different degrees of differences in inflammation,coagulation,and organ dysfunction,with heterogeneity.Conclusion The differences in the source of infection lead to significant differences in the pathophysiological features(inflammatory response,coagulation activation,and organ dysfunction)and short-term prognosis(28-day mortality)of sepsis.