摘要
目的检测老年心力衰竭患者肺部感染病原菌分布,分析发生的危险因素及其对血清降钙素原(PCT)、B型利钠肽(BNP)及D-二聚体(D-Dimer,D-D)水平的影响。方法选取2015年1月-2018年1月本院心内科及重症医学科入住的接受抗心衰治疗的老年患者180例,依据肺部感染情况分为肺部感染组(88例)和非肺部感染组(92例)。收集患者的临床资料并采集痰液或下呼吸道分泌物进行病原菌培养。采集患者外周静脉血,采用电化学发光全自动免疫分析仪检测PCT水平,采用放射免疫法检测BNP水平,采用ELISA检测D-D二聚体水平。结果 88例合并肺部感染的心衰老年患者送检痰液标本检出122株病原菌,在所有纳入的心衰患者中肺部感染发生率为48.89%。既往慢性阻塞性肺疾病、糖尿病、心功能分级较高、住院时间长及接受侵入性操作均是老年心衰患者合并发生肺部感染的独立风险因素(OR值分别为2.741、1.352、3.557、2.613和1.864,均P<0.05)。感染组老年心衰患者血清PCT、BNP、D-D分别为(5.26±0.67)μg/L、(594.46±20.54)μg/L和(2.44±0.57)μg/L,非感染组分别为(0.43±0.02)μg/L、(60.19±10.21)μg/L和(0.38±0.05)μg/L,差异均有统计学意义(t值分别为16.984、22.494和10.4187,P<0.05或P<0.01)。结论老年心衰患者易发生肺部感染,通过监测体内PCT、BNP及D-D的水平,及早防范与既往慢性阻塞性肺疾病、糖尿病、心功能分级较高、住院时间长及接受侵入性操作相关的肺部感染的发生,不仅有助于降低肺部感染发生率,还有助于治疗患者心衰,改善预后。
Objectives To detect the distribution of pathogenic bacteria causing a pulmonary infection in elderly patients with heart failure and to analyze the risk factors and their effects on serum procalcitonin(PCT),B-type natriuretic peptide(BNP),and D-dimer(DD-Dimer,DD).Methods Subjects were 180 elderly patients who were treated for heart failure in Cardiology or Critical Care Medicine from January 2015 to January 2018.Depending on whether patients had a pulmonary infection,patients were divided into those with a pulmonary infection(88 patients)and those without an infection(92 patients).Patient clinical data were collected,and sputum or lower respiratory secretions were collected for pathogen culture.Peripheral venous blood was collected from patients,and PCT levels were detected using an automated electrochemiluminescence immunoassay.BNP levels were detected using a radioimmunoassay,and D-D dimer levels were detected using ELISA.Results Sputum samples from 88 elderly patients with heart failure and a pulmonary infection were examined,and 122 strains of pathogens were detected.The incidence of a pulmonary infection was 48.89%in all patients with heart failure.Previous chronic obstructive pulmonary disease,diabetes,a high grade of cardiac function,a long duration of hospitalization,and an invasive procedure were independent risk factors for pulmonary infection in elderly patients with heart failure(ORs:2.741,1.352,3.557,2.613,and 1.864,P<0.05 for all).Serum PCT,BNP,and DD were 5.26±0.67μg/L,594.46±20.54μg/L,and 2.44±0.57μg/L in elderly patients with an infection and 0.43±0.02μg/L,60.19±10.21μg/L,and 0.38±0.05μg/L in patients without an infection.Differences in serum levels were significant(t:16.984,22.494,and 10.4187,P<0.05 or P<0.01).Conclusion Elderly patients with heart failure are prone to develop a pulmonary infection.Levels of PCT,BNP,and DD in the body need to be monitored for early prevention.Factors associated with development of an infection are previous chronic obstructive pulmonary disease,diabetes,a high grade of cardiac function,a long duration of hospitalization,and an invasive procedure.Reducing the incidence of a pulmonary infection not only helps to reduce the incidence of that infection but also to treat heart failure and improve patient prognosis.
作者
林春生
王世红
LIN Chun-sheng;WANG Shi-hong(Cardiovascular Medicine,Fujian Province Geriatric Hospital,Fuzhou,China 350001)
出处
《中国病原生物学杂志》
CSCD
北大核心
2019年第11期1332-1334,1338,共4页
Journal of Pathogen Biology
