摘要
目的探讨神经重症耐碳青霉烯类肠杆菌科细菌(CRE)感染患者外周血CD64指数、基质金属蛋白酶-9(MMP-9)、淀粉样蛋白A(SAA)水平及意义。方法选取2019年1月至2022年1月在喀什地区第一人民医院神经外科收治的重症CRE感染患者61例作为CRE组,同时选取重症碳青霉烯敏感肠杆菌科细菌(CSE)感染患者100例作为CSE组,比较两组患者临床资料差异,比较CRE组死亡和存活患者临床资料差异,分析CD64指数、MMP-9和SAA鉴别诊断CRE的价值,logistic回归分析CRE感染患者预后的影响因素。结果CRE组患者年龄、高血压、肺部疾病、肝肾疾病、合并症≥2种、抗生素药物应用≥2联、抗生素药物使用时间>10 d、碳青霉烯类使用比例、CD64指数、MMP-9和SAA明显高于CSE组(均P<0.05)。CD64指数、MMP-9和SAA鉴别诊断CRE的受试者工作特征(ROC)曲线下面积分别为0.857、0.701和0.655(均P<0.05)。CRE组死亡患者年龄、入院时急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分)、糖尿病、肝肾疾病、合并症≥2种、碳青霉烯类使用比例、CD64指数、MMP-9和SAA明显高于存活患者(均P<0.05)。Logistic回归分析显示年龄、入院时APACHEⅡ评分、合并症≥2种、CD64指数、MMP-9和SAA是重症CRE患者预后的影响因素(均P<0.05)。结论外周血CD64指数、MMP-9和SAA在诊断神经重症CRE感染中有一定应用价值,同时也是CRE感染患者预后的影响因素。
Objective To investigate the level and significance of CD64 index,matrix metalloproteinase-9(MMP-9)and serum amyloid A(SAA)in peripheral blood of patients with severe carbapenem resistant Enterobacteriaceae(CRE)infection.Methods A total of 61 patients with severe CRE infection who were admitted to the neurosurgery department of Kashgar First People′s Hospital from January 2019 to January 2022 were selected as the CRE group,and 100 patients with severe carbapenem sensitive Enterobacteriaceae(CSE)infection were selected as the CSE group.The difference in clinical data between the two groups was compared,and the difference in clinical data between the dead and surviving patients in the CRE group was compared.The value of CD64 index,MMP-9 and SAA in differential diagnosis of CRE was analyzed.Logistic regression was used to analyze the influencing factors of prognosis in patients with CRE infection.Results The age,hypertension,lung disease,liver and kidney disease,comorbidities≥2,antibiotic use≥2 combinations,antibiotic use time>10 days,proportion of carbapenem use,CD64 index,MMP-9,and SAA of the CRE group patients were significantly higher than those of the CSE group patients(all P<0.05).The area under the receiver operating characteristic(ROC)curve for CD64 index,MMP-9,and SAA differential diagnosis of CRE was 0.857,0.701,and 0.655,respectively(all P<0.05).In the CRE group,the age,the score of Acute Physiological and Chronic Health StatusⅡ(APACHEⅡ)score at admission,diabetes,liver and kidney diseases,comorbidities≥2,the proportion of carbapenems,CD64 index,MMP-9 and SAA of dead patients were significantly higher than those of survivors(all P<0.05).Logistic regression analysis showed that age,APACHEⅡscore at admission,comorbidities≥2,CD64 index,MMP-9,and SAA were influencing factors for the prognosis of severe CRE patients(all P<0.05).Conclusions The peripheral blood CD64 index,MMP-9,and SAA have certain application value in the diagnosis of neurological severe CRE infection,and are also influencing factors for the prognosis of CRE infected patients.
作者
万江丽
甄雅惠
Wan Jiangli;Zhen Yahui(Department of Laboratory,Kashgar First People′s Hospital,Kashgar 844099,China)
出处
《中国医师杂志》
CAS
2023年第5期748-752,共5页
Journal of Chinese Physician
