| 廖明喻,郭晶晶,鲁菲菲,姚义勇,钱进先,曾 刚.AECOPD合并呼吸机相关性肺炎患者病原菌分布及EOS、RDW联合CPIS对预后的评估价值[J].,2023,(9):1755-1760 |
| AECOPD合并呼吸机相关性肺炎患者病原菌分布及EOS、RDW联合CPIS对预后的评估价值 |
| Pathogen Distribution in AECOPD Patients with Ventilator-Associated Pneumonia and the Prognostic Value of EOS, RDW and CPIS |
| 投稿时间：2022-10-03 修订日期：2022-10-26 |
| DOI：10.13241/j.cnki.pmb.2023.09.030 |
| 中文关键词: AECOPD 呼吸机相关性肺炎 病原菌 EOS RDW CPIS 预后 评估价值 |
| 英文关键词: AECOPD Ventilator-associated pneumonia Pathogenic bacteria EOS RDW CPIS Prognosis Evaluation value |
| 基金项目:江苏省卫生计生委医学科研课题（H201689） |
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| 中文摘要: |
| 摘要 目的：分析慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸机相关性肺炎（VAP）患者病原菌分布情况，并探讨嗜酸性粒细胞（EOS）、红细胞分布宽度（RDW）联合临床肺部感染评分（CPIS）对预后的评估价值。方法：选取2019年1月～2022年1月我院收治的82例AECOPD合并VAP患者（VAP组），另选取同期55例未合并VAP的AECOPD患者（非VAP组）；根据VAP组患者治疗后28 d生存情况，将其分为死亡亚组33例和存活亚组49例。检测所有患者外周血EOS、RDW水平并计算CPIS评分，分析AECOPD合并VAP患者病原菌分布情况。采用单因素、多因素Logistic回归分析AECOPD合并VAP患者预后不良的影响因素，采用受试者工作特征（ROC）曲线分析外周血EOS、RDW联合CPIS评分对AECOPD合并VAP患者预后的评估价值。结果： 82例AECOPD合并VAP患者共检测出89株病原菌，革兰氏阴性菌、革兰氏阳性菌、真菌分别占比55.06％、42.70％、2.25％。与非VAP组比较，VAP组外周血EOS、RDW水平及CPIS评分更高（均P＜0.05）。与存活亚组比较，死亡亚组外周血EOS、RDW水平及CPIS评分更高（均P＜0.05）。多因素Logistic回归分析显示，年龄增加和降钙素原、外周血EOS、RDW水平及CPIS评分升高为AECOPD合并VAP患者预后不良的独立危险因素，第1秒用力呼气容积占预计值百分比（FEV1％）升高为其独立保护因素（均P＜0.05）。ROC曲线分析显示，外周血EOS、RDW联合CPIS评分评估AECOPD合并VAP患者预后的曲线下面积（AUC）大于外周血EOS、RDW及CPIS评分单独评估。结论：AECOPD合并VAP患者病原菌以革兰氏阴性菌为主，外周血EOS、RDW水平及CPIS评分升高与患者预后不良密切相关，三者联合对AECOPD合并VAP患者预后的评估价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the distribution of pathogenic bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with ventilator-associated pneumonia (VAP), and to investigate the evaluation value of eosinophils (EOS) and red blood cell distribution width (RDW) combined with clinical pulmonary infection score (CPIS) in prognosis. Methods: 82 patients with AECOPD combined with VAP (VAP group) who were admitted to our hospital from January 2019 to January 2022 were selected, and another 55 patients with AECOPD without VAP (non-VAP group) in the same period were selected. According to the survival of the patients in the VAP group at 28 d after treatment, they were divided into death subgroup with 33 cases and survival subgroup with 49 cases. The levels of peripheral blood EOS and RDW of all patients were detected and CPIS score was calculated, the distribution of pathogenic bacteria in patients with AECOPD combined with VAP were analyzed. Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in patients with AECOPD combined with VAP. The evaluation value of peripheral blood EOS, RDW and CPIS score in patients with AECOPD combined with VAP was analyzed by receiver operating characteristic (ROC) curve. Results: A total of 89 strains of pathogenic bacteria were detected in 82 patients with AECOPD combined with VAP, and Gram-negative bacteria, Gram-positive bacteria and fungi accounted for 55.06%, 42.70% and 2.25%, respectively. Compared with non-VAP group, the levels of peripheral blood EOS, RDW and CPIS score in VAP group were higher (all P＜0.05). Compared with the survival subgroup, the death subgroup had higher peripheral blood EOS, RDW levels and CPI score (all P＜0.05). Multivariate Logistic regression analysis showed that the increased of age and the increased of procalcitonin, peripheral blood EOS, RDW levels and CPIS score were independent risk factors for poor prognosis in patients with AECOPD combined with VAP, and the increased of forced expiratory volume in one second to the predicted value (FEV1%) was independent protective factor (all P＜0.05). ROC curve analysis showed that the area under the curve (AUC) of peripheral blood EOS and RDW combined with CPIS score in evaluating the prognosis of patients with AECOPD combined with VAP was greater than that of peripheral blood EOS, RDW and CPIS scores alone. Conclusion: The pathogenic bacteria of patients with AECOPD combined with VAP are mainly gram-negative bacteria. The increased of peripheral blood EOS, RDW, and CPIS score are closely related to the poor prognosis of patients. The combination of the three is of high value in evaluating the prognosis of patients with AECOPD combined with VAP. |
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