CAJ | 학술논문

目的探讨多重聚合酶链反应技术( m-PCR)对重症急性胰腺炎( SAP)继发感染的诊断价值,为临床SAP抗感染治疗提供依据. 方法选取2011 年1月至2014 年12月期间收治的35例SAP患者,在患者发病7~14 d内抽外周血使用m-PCR法检测患者有无继发性细菌感染, 同时抽取外周血和(或)取CT引导下腹腔穿刺液进行培养,以血培养或穿刺液培养阳性为诊断继发性感染的标准.结果采用m-PCR可同时检测9种肠道常驻致病菌,检测下限为10~1 000个拷贝. 培养法及m-PCR法检出金黄色葡萄球菌分别为6例和5例,表皮葡萄球菌11例和9例,粪肠球菌2例和3例,屎肠球菌6例和7例,大肠埃希菌19例和17例,肺炎克雷伯菌例2例和3例,铜绿假单胞菌6例和4例,鲍曼不动杆菌2例和2例,嗜麦芽窄食单胞菌4例和2例. 35例SAP患者在发病后7~14 d内27例血培养或穿刺液培养阳性 ,8例阴性. 30例m-PCR检测阳性,5例阴性. 3例培养阴性者m-PCR为阳性,其余32例两种检测方法结果一致. 以培养结果为准,m-PCR的灵敏性为100%,特异性为62.5%,准确性为91.43%,阳性预测值90%,阴性预测值100%. 血液或穿刺液从培养到出报告时间为(26 ±15)h,到鉴定结果的报告时间为(102 ±32)h;m-PCR方法从检测到出报告时间为(12 ±8)h. m-PCR检出病原菌的报告时间明显短于传统培养与鉴定结果报告时间,组间差异有统计学意义( P<0.05). 结论 m-PCR可用于监测SAP患者继发细菌感染,其敏感性高,操作时间短,值得临床推广应用.
목적 탐토다중취합매련반응기술( m-PCR)대중증급성이선염( SAP)계발감염적진단개치,위림상SAP항감염치료제공의거. 방법 선취2011 년1월지2014 년12월기간수치적35례SAP환자,재환자발병7~14 d내추외주혈사용m-PCR법검측환자유무계발성세균감염, 동시추취외주혈화(혹)취CT인도하복강천자액진행배양,이혈배양혹천자액배양양성위진단계발성감염적표준.결과 채용m-PCR가동시검측9충장도상주치병균,검측하한위10~1 000개고패. 배양법급m-PCR법검출금황색포도구균분별위6례화5례,표피포도구균11례화9례,분장구균2례화3례,시장구균6례화7례,대장애희균19례화17례,폐염극뢰백균례2례화3례,동록가단포균6례화4례,포만불동간균2례화2례,기맥아착식단포균4례화2례. 35례SAP환자재발병후7~14 d내27례혈배양혹천자액배양양성 ,8례음성. 30례m-PCR검측양성,5례음성. 3례배양음성자m-PCR위양성,기여32례량충검측방법결과일치. 이배양결과위준,m-PCR적령민성위100%,특이성위62.5%,준학성위91.43%,양성예측치90%,음성예측치100%. 혈액혹천자액종배양도출보고시간위(26 ±15)h,도감정결과적보고시간위(102 ±32)h;m-PCR방법종검측도출보고시간위(12 ±8)h. m-PCR검출병원균적보고시간명현단우전통배양여감정결과보고시간,조간차이유통계학의의( P<0.05). 결론 m-PCR가용우감측SAP환자계발세균감염,기민감성고,조작시간단,치득림상추엄응용.
Objective To investigate the diagnostic value of multiplex polymerase chain reaction (m-PCR) for diagnosing second infection of severe acute pancreatitis ( SAP), and to provide evidence for anti-infection treatment of SAP .Methods From January 2011 to December 2014 , thirty five patients of SAP were enrolled .Seven to fourteen days after SAP onset , patients′blood samples were taken and the presence of infection was determined by mP-CR.In the meantime, peripheral blood or the paracentesis fluid was cultured , and the result of culture was regard as golden standard to diagnose infection .Rseults The m-PCR could simultaneously detect 9 kinds of intestinal resident pathogenic bacteria , and the lower limit of detection was 10~1 000 copies.The detection rates were as follows (cultivation vs. m-PCR):staphylococcus aureus 6 vs 5 cases, staphylococcus epidermidis 11 vs 9 cases, enterococcus faecalis 2 vs 3 cases, enterococcus faecium 6 vs 7 cases, escherichia coli 19 vs 17 cases, klebsiella pneumoniae 2 vs 3 cases, pseudomonas aeruginosa 6 vs 4 cases, acinetobacter baumannii 2 vs 2 cases, malt narrow food aeromonas 4 vs2 cases.The 7th~14th days after SAP onset, the blood or paracentesis fluid culture was positive in 27 patients,and negative in 8 cases. And the m-PCR results were positive in 30 patients, and negative in 8 cases.The m-PCR results were positive in 30 patients, negative in 5 patients.The m-PCR results were positive in 3 patients who had negative culture results.In the remaining 32 cases, the results were consistent between the two detection methods .When the culture result was regarded as golden standard , the sensitivity, specificity and accuracy of m-PCR were 100%, 62.5%and 91.43%, respectively.The positive predictive value and the negative predictive value were 90%and 100%, respectively.It took (26 ±15) hours on average to obtain the result of culture method , and it took (102 ±32) hours on average to obtain the confirmative results .It took (12 ±8) hours on average to obtain the result of the m-PCR method.The time course of m-PCRwas significantly shorter than that of the traditional culture method, and the difference was statistically significant (P<0.05).Conclusions The m-PCR method can be used to monitor the bacterial infection in patients with SAP .The m-PCR method is a highly sensitive and rapid detection approach , which is worth of clinical application .