中国医刊
中國醫刊
중국의간
CHINESE JOURNAL OF MEDICINE
2014年
12期
39-42
,共4页
血液透析%中心静脉长期留置导管%导管相关性感染%降钙素原%C反应蛋白
血液透析%中心靜脈長期留置導管%導管相關性感染%降鈣素原%C反應蛋白
혈액투석%중심정맥장기류치도관%도관상관성감염%강개소원%C반응단백
Hemodialysis%Catheter-related infection%Long term central venous catheter%Procalcitonin%C-reactive protein
目的：探讨维持性血液透析患者中心静脉长期留置导管相关性感染( CRI)的临床特征及联合多个炎症指标在其诊断中的作用。方法对33例中心静脉长期留置导管非感染患者和30例中心静脉长期留置CRI患者进行回顾性分析,比较分析两组临床资料及血常规、生化检查、血培养、降钙素原、C反应蛋白、红细胞沉降率等指标。结果 CRI与合并糖尿病、低血浆总蛋白、低血浆白蛋白、低血浆前蛋白相关( P<0.05或P<0.01),与性别、年龄、血肌酐、血红蛋白、白细胞计数无关(P>0.05)。感染组中18例标本细菌培养阳性,共分离出8种病原菌,主要致病菌为金黄色葡萄球菌、表皮葡萄球菌。感染组和非感染组的降钙素原[(6.48±5.63)μg/L和(0.28±0.15)μg/L]、C反应蛋白[(60.45±26.50)mg/L和(3.87±3.77)mg/L]、红细胞沉降率[(68.36±31.67)mm/h和(27.6±16.60)mm/h],差别有显著性(P<0.01或P<0.05)。结论营养状态低下、糖尿病是中心静脉长期留置导管CRI的危险因素,CRI的主要致病菌为金黄色葡萄球菌和表皮葡萄球菌。降钙素原、C反应蛋白、红细胞沉降率的升高均能在一定程度上反映CRI的发生,联合使用多个炎症指标,尤其是降钙素原在CRI的早诊断中发挥重要作用。
目的：探討維持性血液透析患者中心靜脈長期留置導管相關性感染( CRI)的臨床特徵及聯閤多箇炎癥指標在其診斷中的作用。方法對33例中心靜脈長期留置導管非感染患者和30例中心靜脈長期留置CRI患者進行迴顧性分析,比較分析兩組臨床資料及血常規、生化檢查、血培養、降鈣素原、C反應蛋白、紅細胞沉降率等指標。結果 CRI與閤併糖尿病、低血漿總蛋白、低血漿白蛋白、低血漿前蛋白相關( P<0.05或P<0.01),與性彆、年齡、血肌酐、血紅蛋白、白細胞計數無關(P>0.05)。感染組中18例標本細菌培養暘性,共分離齣8種病原菌,主要緻病菌為金黃色葡萄毬菌、錶皮葡萄毬菌。感染組和非感染組的降鈣素原[(6.48±5.63)μg/L和(0.28±0.15)μg/L]、C反應蛋白[(60.45±26.50)mg/L和(3.87±3.77)mg/L]、紅細胞沉降率[(68.36±31.67)mm/h和(27.6±16.60)mm/h],差彆有顯著性(P<0.01或P<0.05)。結論營養狀態低下、糖尿病是中心靜脈長期留置導管CRI的危險因素,CRI的主要緻病菌為金黃色葡萄毬菌和錶皮葡萄毬菌。降鈣素原、C反應蛋白、紅細胞沉降率的升高均能在一定程度上反映CRI的髮生,聯閤使用多箇炎癥指標,尤其是降鈣素原在CRI的早診斷中髮揮重要作用。
목적：탐토유지성혈액투석환자중심정맥장기류치도관상관성감염( CRI)적림상특정급연합다개염증지표재기진단중적작용。방법대33례중심정맥장기류치도관비감염환자화30례중심정맥장기류치CRI환자진행회고성분석,비교분석량조림상자료급혈상규、생화검사、혈배양、강개소원、C반응단백、홍세포침강솔등지표。결과 CRI여합병당뇨병、저혈장총단백、저혈장백단백、저혈장전단백상관( P<0.05혹P<0.01),여성별、년령、혈기항、혈홍단백、백세포계수무관(P>0.05)。감염조중18례표본세균배양양성,공분리출8충병원균,주요치병균위금황색포도구균、표피포도구균。감염조화비감염조적강개소원[(6.48±5.63)μg/L화(0.28±0.15)μg/L]、C반응단백[(60.45±26.50)mg/L화(3.87±3.77)mg/L]、홍세포침강솔[(68.36±31.67)mm/h화(27.6±16.60)mm/h],차별유현저성(P<0.01혹P<0.05)。결론영양상태저하、당뇨병시중심정맥장기류치도관CRI적위험인소,CRI적주요치병균위금황색포도구균화표피포도구균。강개소원、C반응단백、홍세포침강솔적승고균능재일정정도상반영CRI적발생,연합사용다개염증지표,우기시강개소원재CRI적조진단중발휘중요작용。
Objective To investigate clinical features of catheter-related infection and the diagnosis value of multiple inflammatory markers in hemodialysis patients with long term central venous catheter. MethOd The clinical general data of thirty-three cases without CRI and thirty cases with CRI in hemodialysis patients with long term central ve-nous catheter were analyzed retrospectively. Routine blood test,biochemical examination, blood culture,serum lev-els of procalcitonin( PCT) ,C-reactive protein( CRP) ,erythrocyte sedimentation rate ( ESR) , were compared. Result CRI was related to the combination with diabetes,low plasma total albumin,low plasma albumin and low plasma pre albumin(P<0. 05),while was not related to sex,age,white blood cell count,hemoglobin,serum creatinine. Bacterial culture of eighteen samples turned out to be positive,and eight kinds of pathogenic bacteria were isolated, Staphylo-coccus aureus and Staphylococcus epidermidis were the main pathogenic bacteria. There was significantly statistical difference between CRI group and non-CRI group on values of PCT[(6. 48±5. 63)μg/L vs (0. 28±0. 15)μg/L], CRP[(60. 45±26. 50)mg/L vs (3. 87±3. 77)mg/L],ESR[(68. 36±31. 67)mm/h vs (27. 6±16. 60)mm/h](P<0. 05 or P<0. 01). COnclusiOn Combination of diabetes and low nutrition state are the related risk factors of CRI. Staphylococcus aureus and staphylococcus epidermidis are the main pathogenic bacteria of CRI. To some extense,the increase of PCT, CRP and ESR may show the occurrence of CRI and multiple inflammatory markers,especially PCT may play an important role in early diagnosis of CRI better than CRP and ESR.
