血液中炎性指标与脓毒血症细菌感染患者病情的相关性研究

Relationship between blood inflammatory markers and patients' condition in bacterial sepsis patients

摘要:

目的  探讨血液中炎性指标与脓毒血症细菌感染患者病情的相关性。方法  选取2010年9月-2015年2月该院收治的脓毒血症细菌感染患者109例，依据病情程度分为脓毒性休克组、严重脓毒血症组、脓毒血症组。统计感染菌分布情况，比较各亚组脓毒血症患者的急性生理和慢性健康评分（APACHE-Ⅱ）、降钙素原（PCT）、C反应蛋白（CRP）、脂多糖（LPS）、白细胞介素-6（IL-6）、白细胞计数（WBC）、中性粒细胞比例（NEUT）等炎性指标水平，并对炎性指标与APACHE-Ⅱ评分进行相关性分析。结果  脓毒血症患者主要感染菌为大肠埃希菌、肺炎克雷伯菌、血浆凝固酶阴性葡萄球菌、金黄色葡萄球菌、假丝酵母菌，感染率分别为22.94%、21.10%、13.76%、11.93%和9.17%，其次为鲍曼不动杆菌（7.34%）、阴沟肠杆菌（5.50%）。脓毒性休克组、严重脓毒血症组、脓毒血症组患者的APACHE-Ⅱ评分分别为（26.27±5.68）、（21.08±4.96）和（12.14±3.75）分。脓毒性休克组、严重脓毒血症组、脓毒血症组患者血液中PCT、CRP、LPS、IL-6、WBC、NEUT等炎性指标水平依次降低，差异有统计学意义（P <0.05）。脓毒血症细菌感染患者的血液中PCT、CRP、LPS、IL-6与APACHE-Ⅱ评分呈正相关（r =0.579、0.734、0.621和0.685，P <0.05）。结论  脓毒血症患者细菌感染以大肠埃希菌、肺炎克雷伯菌、血浆凝固酶阴性葡萄球菌为主，患者血液中PCT、CRP、LPS、IL-6水平与病情呈正相关，可作为预测病情及预后的重要指标。

Abstract:

Objective To investigate the correlation between blood inflammatory markers and patients' condition in patients with sepsis-related bacterial infection. Methods A total of 109 patients, who were admitted to the hospital for sepsis bacterial infections from September 2010 to February 2015, were selected and divided to septic-shock group, severe-sepsis group and sepsis group according to the severity of disease. Distribution of infectious bacteria was investigated. Acute physiology and chronic health evaluation (APACHE-Ⅱ) score, procalcitonin (PCT), C-reactive protein (CRP), lipopolysacchride (LPS), interleukin 6 (IL-6), white blood cell count (WBC), neutrophil percentage (NEUT) and other inflammatory marker levels were compared among the groups; and the correlations between the inflammatory markers and APACHE-Ⅱ score were analyzed. Results The main bacteria of sepsis were Escherichia coli, Klebsiella pneumonia, coagulase-negative Staphylococci, Staphylococcus aureus and Candida yeast with infection rates were 22.94%, 21.10% and 13.76%, 11.93% and 9.17% respectively, followed by Acinetobacter baumannii (7.34%) and Enterobacter cloacae (5.50%). The APACHE-Ⅱ scores of the septic-shock group, the severe-sepsis group and the sepsis group were (26.27 ±5.68), (21.08 ± 4.96) and (12.14 ± 3.75) respectively. The blood PCT, CRP, LPS, IL-6, WBC and NEUT decreased in turn in the septic-shock group, the severe-sepsis group and the sepsis group, and the differences were statistically significant (P < 0.05). In the sepsis patients with bacterial infection, the APACHE-Ⅱ scores were positively correlated with the blood PCT, CRP, LPS and IL-6 (r = 0.579, 0.734, 0.621 and 0.685; P < 0.05). Conclusions The infectious bacteria in sepsis patients are mainly Escherichia coli, Klebsiella pneumonia, plasma coagulase-negative Staphylococcus. Blood PCT, CRP, LPS and IL-6 levels are positively correlated with the severity of the disease, which can be used as indicators for predicting the condition and prognosis.