急性冠脉综合征PCI术后感染病原菌和危险因素及血清miR-223、IL-6、CRP水平

Pathogens,risk factors and serum miR-223,IL-6 and CRP of acute coronary syndrome and PCI patients with postoperative infections

目的探讨急性冠脉综合征(ACS)经皮冠状动脉介入治疗(PCI)术后感染病原菌和危险因素及血清微小核糖核酸-223(miR-223)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平。方法选取2018年1月-2023年6月商丘市第一人民医院行PCI术的680例ACS患者为研究对象,根据PCI术后是否发生感染分为感染组66例和非感染组614例。分离鉴定病原菌;Logistic回归分析影响ACS患者PCI术后感染的危险因素;分析两组血清miR-223、IL-6、CRP水平;受试者工作特征(ROC)曲线分析血清miR-223、IL-6、CRP水平对术后感染的预测价值。结果ACS患者PCI术后感染率为9.71%,共检出病原菌102株,革兰阴性菌占比50.98%,以铜绿假单胞菌和鲍氏不动杆菌为主,革兰阳性菌占比41.18%,真菌占比7.84%。年龄、术前Killip分级和病变血管支数均为影响ACS患者PCI术后感染的危险因素(P<0.05)。感染组血清miR-223、IL-6、CRP水平高于未感染组(P<0.05)。ROC分析,血清miR-223、IL-6、CRP联合检测预测PCI术后感染发生的曲线下面积为0.904,敏感度为78.79%(P<0.05)。结论ACS患者PCI术后感染病原菌以铜绿假单胞菌、鲍氏不动杆菌和金黄色葡萄球菌为主,感染可引起血清miR-223、IL-6、CRP水平异常升高,三指标联合检测对术后感染风险具有较好的预测效能。

OBJECTIVE To explore the pathogens,risk factors and serum microribonucleic acid-223(miR-223),interleukin-6(IL-6)and C-reactive protein(CRP)in the acute coronary syndrome(ACS)patients who underwent percutaneous coronary intervention(PCI)and had postoperative infections.METHODS A total of 680 ACS patients who underwent PCI in Shangqiu First People′s Hospital from Jan.2018 to Jun.2023 were recruited as the research subjects and were divided into the infection group with 66 cases and the non-infection group with 614 cases according to the status of postoperative infection.The pathogens were isolated and identified.Logistic regression analysis was performed for the risk factors for the postoperative infections in the ACS patients.The levels of serum miR-223,IL-6 and CRP were observed and compared between the two groups.The values of serum miR-223,IL-6 and CRP in prediction of the postoperative infections were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The incidence of postoperative infections was 9.71%among the ACS patients undergoing PCI.Totally 102 strains of pathogens were isolated,50.98%of which were gram-negative bacteria,41.18%were gram-positive bacteria,and 7.84%were fungi.Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant species of the gram-negative bacteria.The age,preoperative Killip grade and number of pathologically changed vessels were the risk factors for the postoperative infections in the ACS patients undergoing PCI(P<0.05).The levels of serum miR-223,IL-6 and CRP of the infection group were significantly higher than those of the no infection group(P<0.05).ROC curve analysis showed that the area under the curve of the joint detection of serum miR-223,IL-6 and CRP was 0.904 in prediction of postoperative infections in the patients undergoing PCI,with the sensitivity 78.79%(P<0.05).CONCLUSIONS P.aeruginosa,A.baumannii and Staphylococcus aureus are dominant among the pathogens isolated from the ACS and PCI patients with postoperative infections.The infections may lead to the abnormal rise of serum miR-223,IL-6 and CRP.The joint detection of the three indexes has high efficiency in prediction of the risk of postoperative infections.