摘要
目的 探究慢性阻塞性肺疾病(COPD)合并肺部感染(PI)病原菌分布及其与中性粒细胞与淋巴细胞计数比值(NLR)、巨噬细胞炎症蛋白-1α(MIP-1α)、高迁移率族蛋白1(HMGB1)的关联.方法 随机选取2021年3月-2023年3月成都市第三人民医院收治的发生PI和未发生PI的COPD患者分别纳入感染组(51例)和非感染组(83例),分析COPD发生PI的病原菌分布,通过Logistic分析法分析COPD患者发生PI的危险因素,受试者工作特征(ROC)曲线评估NLR、MIP-1α、HMGB1对COPD患者发生PI的诊断价值.结果 51例发生PI的COPD患者共检出病原菌59株,其中革兰阴性菌、革兰阳性菌、真菌占比分别为64.41％、25.42％、10.17％;COPD患者PI发生的危险因素包括合并糖尿病、长期使用糖皮质激素、抗菌药物使用时间＞14 d、住院时间＞14 d、机械通气(OR=3.043、2.956、2.583、3.019、2.604,均 P＜0.05);感染组外周血 NLR、MIP-1α、HMGB1 表达水平均高于非感染组(P＜0.05),NLR、MIP-1α、HMGB1联合检测诊断COPD患者发生PI的曲线下面积(AUC)值高于单一检测值(P＜0.05),联合检测的敏感度、特异度为94.12％、80.72％.结论 COPD患者PI病原菌以革兰阴性菌为主;COPD患者PI发生与糖尿病、长期使用糖皮质激素、抗菌药物使用时间、住院时间、机械通气有关;且外周血NLR、MIP-1α、HMGB1在COPD合并PI患者呈高表达,且三者联合检测可提高其诊断价值.
Abstract
OBJECTIVE To explore the etiological characteristics of chronic obstructive pulmonary disease(COPD)with pulmonary infection(PI)and its association with neutrophil to lymphocyte ratio(NLR),macrophagic inflam-matory protein(MIP)-1α and high mobility group protein 1(HMGB1).METHODS COPD patients who were ad-mitted to Chengdu Third People's Hospital from Mar.2021 to Mar.2023 were randomly included and allocated in-to the PI group with 51 cases and the non-infection group with 83 cases.The etiological characteristics of COPD with PI were analyzed,and the risk factors for PI occurrence in COPD patients were calculated by Logistic analy-sis.The expression levels of NLR,MIP-1α and HMGB1 in peripheral blood of the PI group and the non-infection group were compared.The diagnostic value of NLR,MIP-1α and HMGB1 for COPD with PI were analyzed by the receiver operating characteristic curve(ROC).RESULTS A total of 59 strains of pathogenic bacteria were detected in 51 COPD patients with PI,and the proportion from high to low was Gram-negative bacteria,Gram-positive bacteria and fungi.The risk factors for PI occurrence in COPD patients were diabetes mellitus,long-term usage of glucocorticoids,antimicrobial usage above 14 days,hospitalizing above 14 days,and mechanical ventilation(OR=3.043,2.956,2.583,3.019,2.604,P＜0.05,respectively).The PI group had significantly higher levels of NLR,MIP-1α,and HMGB1 in peripheral blood than the non-infection group(P＜0.05).The area under the re-ceiver operating characteristic curve(AUC)value of the combined detection of NLR,MIP-1α and HMGB1 in the diagnosis of PI in COPD patients was higher than that of single index above(P＜0.05),and the sensitivity and specificity of the combined detection was 94.12％and 80.72％,respectively.CONCLUSIONS The major patho-genic bacteria of PI in COPD patients is Gram-negative bacteria.The occurrence of PI in COPD patients is related to diabetes mellitus,long-term usage of glucocorticoids,antimicrobial usage,length of hospital stay and mechani-cal ventilation.NLR,MIP-1α and HMGB1 are highly expressed in peripheral blood of COPD with PI patients,and combined detection of the three indexes can improve their diagnostic value.
维普
万方数据