摘要
目的探讨老年2型糖尿病足(DF)患者耐甲氧西林金黄色葡萄球菌(MRSA)感染与免疫功能及预后的关系。方法取2015年10月至2020年7月本院诊治的518例老年DF患者的足部溃疡底部分泌物进行培养,记录DF患者MRSA感染、甲氧西林敏感金黄色葡萄球菌(MSSA)感染情况,并分为MRSA感染组、MSSA感染组。比较MRSA感染组、MSSA感染组DF患者免疫功能指标水平;随访6个月的DF合并MRSA感染患者根据预后情况分为预后良好组和预后不良组,比较两组一般资料及免疫功能指标水平;Logistic回归分析影响DF合并MRSA感染患者预后的因素;采用受试者工作特征曲线(ROC曲线)评价CD3^(+)、CD4^(+)/CD8^(+)对DF合并MRSA感染患者预后的预测价值。结果518例老年DF患者中获得138株金黄色葡萄球菌(SA)(SA感染138例),其中MRSA 74株(MRSA感染74例,占SA感染的53.62%),MSSA 64株(MSSA感染64例,占SA感染的46.38%)。MRSA感染组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平低于MSSA感染组(P<0.05);预后不良组DF合并MRSA感染患者入院前6个月抗生素使用占比高于预后良好组(P<0.05),CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平低于预后良好组(P<0.05)。入院前6个月抗生素使用情况是影响DF合并MRSA感染患者预后不良的危险因素(P<0.05),CD3^(+)、CD4^(+)/CD8^(+)是影响DF合并MRSA感染患者预后不良的保护因素(P<0.05)。CD3^(+)、CD4^(+)/CD8^(+)预测DF合并MRSA感染患者预后的曲线下面积(AUC)分别为0.891、0.871,截断值分别为39.13%、1.10,灵敏度分别为90.0%、86.7%,特异性分别为79.5%、81.8%;两者联合预测DF合并MRSA感染患者预后的AUC为0.949,其灵敏度、特异性分别为86.7%、92.2%。结论老年2型DF合并MRSA感染患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较低,与预后显著相关,且CD3^(+)、CD4^(+)/CD8^(+)联合可更好的预测DF合并MRSA感染患者预后情况。
Objective To investigate the relationship between methicillin-resistant Staphylococcus aureus(MRSA)infection with immune function and prognosis in elderly patients with type 2 diabetic foot(DF).Methods Foot ulcer base secretions of 518 elderly patients with DF who were diagnosed and treated in our hospital from October,2015 to July,2020 were cultured,and MRSA infections and methicillin-sensitive Staphylococcus aureus(MSSA)infections in DF patients were recorded.Based on the results,patients were divided into the MRSA infection group and MSSA infection group.The immune function index levels of DF patients in the MRSA infection group and the MSSA infection group were compared;Patients with DF and MRSA infection who were followed up for 6 months were divided into the good prognosis group and the poor prognosis group according to their prognosis,and the general information and immune function index levels were compared between the two groups;Logistic regression analysis was applied to analyze the factors affecting the prognosis of patients with DF combined with MRSA infection;Receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive value of CD3^(+),CD4^(+)/CD8^(+)on the prognosis of patients with DF combined with MRSA infection.Results A total of 138 strains of Staphylococcus aureus(SA)(138 cases of SA infection)were obtained from 518 elderly DF patients,of which 74 strains were MRSA(74 cases of MRSA infection,accounting for 53.62%of SA infections),and 64 strains were MSSA(64 cases of MSSA infection,accounted for 46.38%of SA infections).Levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)of patients in the MRSA infection group were lower than those in the MSSA infection group(P<0.05);The proportion of antibiotics used in patients with DF and MRSA infection in the poor prognosis group 6 months before admission was higher than that in the good prognosis group(P<0.05),and levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were lower than those in the good prognosis group(P<0.05).Use of antibiotics 6 months before admission was a risk factor affecting the poor prognosis of patients with DF combined with MRSA infection(P<0.05),and CD3^(+),CD4^(+)/CD8^(+)were protective factors affecting the poor prognosis of patients with DF combined with MRSA infection(P<0.05).Area under the curve(AUC)of CD3^(+)and CD4^(+)/CD8^(+)for predicting the prognosis of patients with DF combined with MRSA infection were 0.891 and 0.871,respectively,and the cut-off value were 39.13%and 1.10,respectively,with the sensitivity of 90.0%and 86.7%,and the specificity of 79.5%and 81.8%,respectively;AUC of the two combined prediction for predicting the prognosis of patients with DF combined with MRSA infection was 0.949,and the sensitivity and specificity were 86.7%and 92.2%,respectively.Conclusion Levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in elderly patients with type 2 DF combined with MRSA infection are low,and are significantly related to the prognosis.The combination of CD3^(+)and CD4^(+)/CD8^(+)can better predict the prognosis of patients with DF combined with MRSA infection.
作者
冉涛
周显东
庞会
陈旭
潘峰
王永红
RAN Tao;ZHOU Xiandong;PANG Hui;CHEN Xu;PAN Feng;WANG Yonghong(Department of Laboratory Medicine, Qianjiang Central Hospital of Chongqing, Chongqing 409000, China)
出处
《标记免疫分析与临床》
CAS
2021年第12期2092-2097,共6页
Labeled Immunoassays and Clinical Medicine
基金
重庆市黔江区科技计划项目(编号:2017026)。
关键词
老年
糖尿病足
耐甲氧西林金黄色葡萄球菌
免疫功能
预后
Elderly
Diabetic foot
Methicillin-resistant Staphylococcus aureus
Immune function
Prognosis
