目的 探讨老年膝关节置换术后肺部感染患者病原学特点及外周血程序性死亡受体-1(PD-1)、内毒素(ET)及肠脂肪酸结合蛋白(I-FABP)的预测价值.方法 选取2017年9月-2023年7月在新乡医学院第一附属医院行膝关节置换术的老年患者854例为研究对象,根据患者是否合并感染分为感染组和非感染组.收集所有研究对象的临床资料,统计分析术后肺部感染患者病原学特点,分别于术后1、3、7 d检测外周血PD-1、ET及I-FABP水平,采用受试者工作特征(ROC)曲线分析法探讨上述指标对老年膝关节置换术后肺部感染的预测价值.结果 本组纳入854例老年膝关节置换患者中,有90例患者出现肺部感染,感染发生率为10.54％;共分离出65株病原菌,革兰阴性菌占比为72.31％,革兰阳性菌占24.62％,真菌占3.08％;药敏分析显示,主要革兰阴性菌对氨苄西林、头孢唑林的耐药性较高,对亚胺培南、美罗培南较敏感;主要革兰阳性菌对青霉素的耐药性较高,对万古霉素无耐药性;术后1、3、7 d,感染组患者的外周血PD-1、ET及I-FABP水平均高于非感染组(P＜0.05);术后3 d PD-1、ET及I-FABP预测老年膝关节置换术后肺部感染的曲线下面积(AUC)高于术后1 d和7 d;术后3 d PD-1、ET及I-FABP联合预测的AUC高于单一指标(P＜0.05).结论 外周血PD-1、ET及I-FABP水平在老年膝关节置换术后肺部感染患者术后3 d中持续升高,三者可作为术后肺部感染标志物.
Pathogens and predictive value of peripheral blood PD-1,endotoxin and I-FABP on pulmonary infection after total knee arthroplasty in elderly patients
OBJECTIVE To explore etiological characteristics and the predictive value of peripheral blood pro-grammed cell death-1(PD-1),endotoxin(ET)and intestinal fatty acid binding protein(I-FABP)in elderly pa-tients with pulmonary infection after total knee arthroplasty.METHODS A total of 854 elderly patients undergoing total knee arthroplasty in the First Affiliated Hospital of Xinxiang Medical University between Sep 2017 and Jul 2023 were enrolled in the study.According to whether pulmonary infection occurred,they were divided into the in-fection group and non-infection group.The clinical data of all patients were collected and etiological characteristics were analyzed.On the 1st,3rd and 7th day after surgery,levels of peripheral blood PD-1,ET and I-FABP were detected,and their predictive value on pulmonary infection was explored by receiver operating characteristic(ROC)curves.RESULTS Among the 854 elderly patients with knee arthroplasty,there were 90 cases(10.54％)with pulmonary infection.In the infection patients,65 strains of pathogens were isolated,and proportions of gram-negative bacteria,gram-positive bacteria and fungi were 72.31％,24.62％and 3.08％,respectively.Drug sensitivity analysis showed that drug-resistant rates of the main gram-negative bacteria were high to ampicillin and cefazolin,and they were sensitive to imipenem and meropenem.The drug-resistant rates of the main gram-positive bacteria were high to penicillin,but they were drug-sensitive to vancomycin.On the 1st,3rd and 7th day after sur-gery,levels of peripheral blood PD-1,ET and I-FABP in the infection group were higher than those in the non-in-fection group(P＜0.05).Area under curve(AUC)values of PD-1,ET and I-FABP for predicting pulmonary in-fection on 3rd day after surgery were higher than those on the 1st and 7th day after surgery.On the 3rd day after surgery,AUC of the combined detection of the three indexes was larger than that of individual detection(P＜0.05).CONCLUSION The levels of peripheral blood PD-1,ET and I-FABP continue to increase in elderly patients with pulmonary infection there days after total knee arthroplasty,and three indexes can be applied as predictive markers of postoperative pulmonary infection.
Knee arthroplastyPostoperative pulmonary infectionProgrammed cell death-1EndotoxinIntesti-nal fatty acid binding protein
NETL
NSTL
万方数据
