摘要
目的研究分析重症监护室(intensive care unit,ICU)行气管切开患者下呼吸道感染危险因素及血清干扰素-γ诱导蛋白10(IFN-γinducible protein 10,IP-10)、α1-酸性糖蛋白(α1-acidglycoprotein,AAG)水平及2者联合对患者下呼吸道感染的预测价值。方法选取2019年3月至2024年9月在河北省沧州中西医结合医院ICU治疗并行气管切开的296例患者为研究对象,根据是否发生下呼吸道感染分为感染组(n=119)和非感染组(n=177),根据病情程度分为轻度组(n=58)、中度组(n=37)和重度组(n=24)。Logistic回归分析分析ICU行气管切开患者下呼吸道感染的影响因素;受试者工作特征曲线分析IP-10、AAG对ICU行气管切开患者下呼吸道感染的预测价值;Spearman相关性分析分析血清IP-10、AAG水平与病情程度相关性。结果感染组患者的ICU入住时间,气道开放时间,使用呼吸机>7 d、抗生素>2类及抗生素使用>2周患者占比,行气管切开术前血清IP-10、AAG、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)水平均显著高于非感染组,且差异具有统计学意义(P均<0.05)。患者ICU入住时间、气道开放时间、呼吸机使用时间、抗生素使用时间、抗生素类型以及血清IP-10、AAG、CRP、PCT均为影响患者发生下呼吸道感染的危险因素(P均<0.05);血清IP-10、AAG联合预测患者下呼吸道感染的曲线下面积显著优于IP-10、AAG单独预测(P均<0.05)。中、重度组的血清IP-10、AAG水平较轻度组显著升高(P均<0.05),IP-10、AAG水平与病情程度呈正相关(P均<0.05)。结论ICU行气管切开继发下呼吸道感染患者血清IP-10、AAG水平升高,对患者下呼吸道感染具有辅助预测价值;患者ICU入住时间、气道开放时间、呼吸机使用时间、抗生素使用时间、抗生素类型以及血清IP-10、AAG、CRP、PCT为影响ICU气管切开患者下呼吸道感染的危险因素。
Objective To analyze the risk factors of lower respiratory tract infection and the predictive value of interferon gamma inducible protein 10(IP-10)and alpha l-acidic glycoprotein(AAG)in the intensive care unit(ICU)patients undergoing tracheostomy.Methods From March 2019 to September 2024,296 patients who underwent ICU tracheostomy in our hospital were included as subjects.They were separated into an infected group(n=119)and an uninfected group(n=177)based on the occurrence of lower respiratory tract infection,and the infected group was divided into mild group(n=58),moderate group(n=37)and severe group(n=24)according to the extent of the disease.I Logistic regression was applied to analyze the influencing factors of lower respiratory tract infectiops in ICU patients undergoing tracheostomy.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of IP-10 and AAG for lower respiratory tract infections in ICU patients undergoing tracheostomy.Spearman correlation was used to analyze the correlation between IP-10,AAG.levels and the severity of the disease.Results Compared withl the uninfected group,the ICU stay time,airway opening time,the percentage of use of ventilator>7 d,antibiotics>2 classes,antibiotie use>2 weeks and the levels of serum IP-10,AAG,C-reactive protein(CRP)and procalcitonin(PCT)in the infected group were obviously increased(P<0.05).The ICU stay time,airway opening time,ventilator use time,antibiotic use time,antibiotic type,and the levels of serum IP-10,AAG,CRP and PCT were all risk factors that affecting the occurrence of lower respiratory tract infections in patients(P<0.05).The AUC of the IP-10,AAG combined prediction was obviously better than IP-10 and AAG alone(P≤0.05).Compared with the mild group,the serum IP-10 and AAG levels in the moderate group and severe group were obviously increased(P<0.05).The levels of IP-10 and AAG were positively correlated with the severity of the disease(r=0.409,0.428,P<0.05).Conclusions The ICU stay time,airway opening time,ventilator use time,antibiotic use time,types of antibiotic,and the levels of serum IP-10,AAG,CRP and PCT are risk factors affecting lower respiratory tract infection in ICU tracheostomy patients.Among patients with secondary lower respiratory tract infection after tracheostomy in ICU,serum IP-10 and AAG levels are obviously increased.IP-10 and AAG have certain early auxiliary predictive value for lower respiratory tract infection in patients.
作者
郑然
张杰
孙辰
边新娣
贾宇彤
ZHENG Ran;ZHANG Jie;SUN Chen;BIAN Xindi;JIA Yutong(Department of Emergency,Cangzhou Integrated Chinese and W estern Medicine Hospital,061001,China)
出处
《传染病信息》
2025年第4期394-398,402,共6页
Infectious Disease Information
基金
河北省中医药类科学研究课题计划项目(2022241)。
关键词
重症监护室
气管切开
下呼吸道感染
干扰素-γ诱导蛋白10
Α1-酸性糖蛋白
早期预测
intensive care unit
tracheotomy
lower respiratory tract infection
interferon gamma induced protein 10
Alpha 1-acidic glycoprotein
early prediction
