神经外科重症患者CRE感染发生危险因素及NLR、PCT、MCP-1对感染的鉴别诊断价值

doi:10.3969/j.issn.1007-3205.2022.03.019

河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (3): 339-344.doi: 10.3969/j.issn.1007-3205.2022.03.019

神经外科重症患者CRE感染发生危险因素及NLR、PCT、MCP-1对感染的鉴别诊断价值

湖南省郴州市第一人民医院检验医学中心，湖南郴州 423000

出版日期:2022-03-25 发布日期:2022-04-14
作者简介:张林（1985-），女，湖南邵阳人，湖南省郴州市第一人民医院检验师，医学硕士，从事微生物检验研究。
基金资助:
湖南省自然科学基金项目（S2019JJQNJJ211）

Risk factors of CRE infection in critically ill patients undergoing neurosurgery and the value of NLR, PCT and MCP-1 in differential diagnosis of infection

Department of Laboratory Medicine Center, the First People′s Hospital of Chenzhou City, Hunan Province, Chenzhou 423000, China

Online:2022-03-25 Published:2022-04-14

摘要/Abstract

摘要：

目的探讨神经外科重症患者耐碳青霉烯肠杆菌科细菌（carbapenem resistant enterobacteriaceae，CRE）感染发生危险因素及中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）、降钙素原（procalcitonin，PCT）、单核细胞趋化蛋白1（monocyte chemo-attractant protein-1，MCP-1）对感染的鉴别诊断价值。

方法选取我院神经外科重症感染患者122例作为研究对象，包括61例CRE感染、61例碳青霉烯敏感肠杆菌科细菌（carbapenem-sensitive enterobacteriaceae，CSE）感染，比较两组临床资料、NLR、PCT、MCP-1，Logistic分析CRE感染发生危险因素，Pearson分析NLR、PCT、MCP-1与急性生理与慢性健康评分（Acute Physiology and Chronic Health Score，APACHEⅡ评分）相关性，ROC分析NLR、PCT、MCP-1对神经外科重症患者CRE感染的鉴别诊断价值，KM曲线分析NLR、PCT、MCP-1高水平组、低水平组生存率。

结果两组抗生素药物应用、抗生素药物使用时间、碳青霉烯类使用、APACHEⅡ评分、NLR、PCT、MCP-1水平比较，差异有统计学意义（P＜0.05）；抗生素药物应用≥2联、抗生素药物使用时间＞10 d、碳青霉烯类使用、APACHEⅡ评分≥20分、NLR、PCT、MCP-1高水平表达均为神经外科重症患者CRE感染的危险因素（P＜0.05）；神经外科重症CRE感染患者NLR、PCT、MCP-1与APACHEⅡ评分呈正相关关系（P＜0.05）；联合诊断CRE感染AUC值大于单一诊断（P＜0.05）；CRE感染患者NLR、PCT、MCP-1高水平组病死率高于低水平组（P＜0.05）。

结论神经外科重症患者CRE感染受多种因素影响，其中NLR、PCT、MCP-1与病情程度密切相关，有助于CRE感染的鉴别诊断，临床可据此采取针对性干预措施，预防CRE感染的发生。

关键词:

肠杆菌科感染, 降钙素原, 趋化因子CCL2

Abstract:

Objective To investigate the risk factors of CRE infection and the value of neutrophil-to-lymphocyte ratio(NLR), procalcitonin(PCT), monocyte chemo-attractant protein-1(MCP-1) in the differential diagnosis of infection in critically ill patients undergoing neurosurgery.

Methods In total, 122 patients with severe infection in Department of Neurosurgery of our hospital were selected as the research subjects, including 61 cases of carbapenem-resistant Enterobacteriaceae(CRE) infections and 61 cases of carbapenem-sensitive Enterobacteriaceae(CSE) infections. The clinical data, NLR, PCT, MCP-1 of the two groups were compared, and the risk factors of CRE infection were analyzed by Logistic regression. Pearson analysis was used to analyze the correlation between NLR, PCT, MCP-1 and acute physiology and chronic health(APACHEⅡ) score, and ROC was used to analyze the differential diagnosis value of NLR, PCT, and MCP-1 in critically ill patients with CRE infection undergoing neurosurgery. KM curve was used to analyze the survival rate of NLR, PCT, MCP-1 high-level group and low-level group.

Results There was a statistically significant difference between two groups with respect to antibiotic drug application, duration of antibiotic drug use, carbapenem use, APACHEⅡ score, NLR, PCT and MCP-1 levels(P＜0.05). The use of antibiotics ≥ 2 combinations, the duration of antibiotics use ≥ 10 days, the use of carbapenems, the APACHE Ⅱ score≥20, NLR, PCT, and MCP-1 high-level expression were all risk factors for CRE infection in critically ill patients undergoing neurosurgery(P＜0.05). There was a positive correlation between NLR, PCT, MCP-1 and APACHEⅡ score in patients with severe CRE infection undergoing neurosurgery(P＜0.05). AUC value of combined diagnosis of CRE infection was greater than single diagnosis(P＜0.05). The mortality of patients with high levels of NLR, PCT and MCP-1 in CRE infection was higher than that in the low-level group(P＜0.05).

Conclusion CRE infection in critically ill patients undergoing neurosurgery is affected by multiple factors. Among them, NLR, PCT, and MCP-1 are closely related to the severity of the disease, which is conductive to the differential diagnosis of CRE infection. Therefore, targeted intervention measures can be taken accordingly to prevent the occurrence of CRE infection.

Key words: enterobacteriaceae infection, procalcitonin, chemokine CCL2

张林, 雷小保, 熊劲芝, 黄强, 李娜. 神经外科重症患者CRE感染发生危险因素及NLR、PCT、MCP-1对感染的鉴别诊断价值[J]. 河北医科大学学报, 2022, 43(3): 339-344.

ZHANG Lin, LEI Xiao-bao, XIONG Jin-zhi, HUANG Qiang, LI Na. Risk factors of CRE infection in critically ill patients undergoing neurosurgery and the value of NLR, PCT and MCP-1 in differential diagnosis of infection[J]. Journal of Hebei Medical University, 2022, 43(3): 339-344.

[1]	张欣. 血液CC16、PCT、FKN水平与慢性阻塞性肺疾病患者衰弱的临床研究 [J]. 河北医科大学学报, 2023, 44(9): 1027-1031.
[2]	徐琦量, 陈晓明, 戴强, 施文娟, 周剑, 蒋逸. 血乳酸、降钙素原清除率对烧伤休克患者预后的预测价值 [J]. 河北医科大学学报, 2023, 44(8): 941-944,951.
[3]	李素华, 苗毅, 张爱民. 血清PCT、NT-proBNP、mtDNA水平与CPB心脏术后早期并发症的关系及其预测价值研究 [J]. 河北医科大学学报, 2023, 44(5): 536-540,595.
[4]	房启文, 李海新, 许娜娜, 马思思, 王蕾, 董志玲. PCT、hs-CRP及sPLA2-ⅡA检测在脓毒症临床评价中的应用价值 [J]. 河北医科大学学报, 2023, 44(10): 1157-1161，1184.
[5]	张赟, 陈娟, 黄尧米. 血浆Th1/Th2细胞、ET、PTA、PCT与脓毒症患儿病情严重程度及转归的关系分析 [J]. 河北医科大学学报, 2022, 43(12): 1449-1453.
[6]	张鹏1，张迪1，李向科2，韩永台2，申勇1. 降钙素原水平与髋关节结核病变严重程度及预后的相关性研究[J]. 河北医科大学学报, 2020, 41(4): 405-408.
[7]	安良斌, 温航卫, 刘作姣. 血清PCT、ALB、PSP联合预测脓毒症患儿预后的临床价值[J]. 河北医科大学学报, 2020, 41(11): 1306-1310.
[8]	赵志芳1，李旭泽2，赵云霞1，李亚华1，王东昌1，陈〓刚1*. 降钙素原、C反应蛋白鉴别肺癌患者肿瘤热与感染性发热的价值[J]. 河北医科大学学报, 2018, 38(5): 500-503.
[9]	王〓钧，任瑞华，高〓勇*，侯宏伟,王〓亮，孙金昊. 肺部感染评分、降钙素原及C反应蛋白对特发性肺纤维化并发感染的诊断意义[J]. 河北医科大学学报, 2016, 37(7): 780-783.
[10]	崔颖;高慧;齐浩. 血清降钙素原在妊娠中期急性肾盂肾炎治疗中的指导作用[J]. , 2015, 36(9): 1074-1074.
[11]	高勇;梅丽;王晓静;牛艳慧;王钧. 重度缺血性卒中无感染患者的降钙素原动态变化[J]. , 2015, 36(8): 887-887.
[12]	高勇;王晓静;李宁. 降钙素原下降率对脓毒血症治疗及预后评估的意义[J]. , 2015, 36(7): 768-768.
[13]	王晓静;高勇;李宁;王鑫. 连续性血液滤过对脓毒症休克患者PCT清除的影响[J]. , 2015, 36(10): 1177-1177.
[14]	王志刚;王晓玲;吴景华. 血培养阳性患者C反应蛋白和降钙素原水平检测[J]. , 2014, 35(8): 957-957.
[15]	李梅;江莲;刁玉巧;张会芬;刘翠萍;戎小平. 小儿全身炎症反应综合征降钙素原水平的测定及其临床意义[J]. , 2009, 30(3): 292-292.

神经外科重症患者CRE感染发生危险因素及NLR、PCT、MCP-1对感染的鉴别诊断价值

Risk factors of CRE infection in critically ill patients undergoing neurosurgery and the value of NLR, PCT and MCP-1 in differential diagnosis of infection

HTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价