作者：朱雪丽，林照坤，王丽芸

单位：

海南医学院第一附属医院感染科

单位（英文）：

Department of Infection, the First Affiliated Hospital of Hainan Medical College, Haikou 570102, China

关键词：

肺肿瘤; 肺部感染; 病原菌; 降钙素原; 影响因素分析;

关键词（英文）：

Lung neoplasms; Pulmonary infection; Pathogenic bacteria; Procalcitonin; Root cause analysis

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2023.00.102

基金项目：

海南省卫生计生行业科研项目（18A200066）

摘要：

目的 探讨肺鳞癌根治术后肺部感染病原菌特征及其影响因素，并分析降钙素原（PCT）、C反应蛋白（CRP）/前白蛋白（PA）鉴别诊断肺鳞癌根治术后肺部感染病原菌的价值。方法 选取2018年5月至2022年3月海南医学院第一附属医院收治的肺鳞癌根治术后肺部感染的患者76例为观察组，另选取同期肺鳞癌根治术后未发生肺部感染的患者76例为对照组。比较两组PCT、CRP/PA，分析观察组病原菌情况及主要病原菌耐药情况，比较观察组革兰阴性菌与革兰阳性菌感染患者PCT、CRP/PA，采用单因素及多因素Logistic回归分析探讨肺鳞癌根治术后肺部感染病原菌的影响因素；采用ROC曲线分析PCT、CRP/PA及二者联合鉴别诊断肺鳞癌根治术后肺部感染病原菌的价值。结果 观察组PCT、CRP/PA较对照组升高（P<0.05）。观察组76份标本共检出76株病原菌，其中革兰阴性菌55株（72.4%）、革兰阳性菌21株（27.6%）。肺炎克雷伯菌、鲍曼不动杆菌对氨苄西林耐药率为100.0%，金黄色葡萄球菌对青霉素耐药率为100.0%。革兰阴性菌感染患者PCT、CRP/PA较革兰阳性菌感染患者升高（P<0.05）。单因素Logistic回归分析结果显示，麻醉用时、预防性使用抗菌药物、PCT、CRP/PA可能是肺鳞癌根治术后肺部感染病原菌的影响因素（P<0.05）；多因素Logistic回归分析结果显示，PCT、CRP/PA是肺鳞癌根治术后肺部感染病原菌的独立影响因素（P<0.05）。ROC曲线分析结果显示，PCT、CRP/PA及二者联合鉴别诊断肺鳞癌根治术后肺部感染病原菌的AUC分别为0.816、0.839、0.926，二者联合鉴别诊断肺鳞癌根治术后肺部感染病原菌的AUC大于PCT、CRP/PA(P<0.05)。结论肺鳞癌根治术后肺部感染者PCT、CRP/PA明显升高，病原菌以革兰阴性菌为主，PCT、CRP/PA是肺鳞癌根治术后肺部感染病原菌的独立影响因素，且二者联合对肺鳞癌根治术后肺部感染病原菌鉴别诊断价值较高，这可为临床早期经验用药提供方向。

英文摘要：

Objective To investigate the pathogenic bacteria characteristics of pulmonary infection after radical resection for lung squamous cell carcinoma and its influencing factors, and analyze the value of procalcitonin (PCT) , C-reactive protein (CRP) /prealbumin (PA) in differentiating and diagnosing pathogenic bacteria of pulmonary infection after radical resection for lung squamous cell carcinoma. Methods A total of 76 patients with pulmonary infection after radical resection for lung squamous cell carcinoma in the First Affiliated Hospital of Hainan Medical College from May 2018 to March 2022 were selected as the observation group. A total of 76 patients without pulmonary infection after radical resection for lung squamous cell carcinoma during the same period were selected as the control group. The PCT and CRP/PA were compared between the two groups. The situation of pathogenic bacteria and the drug resistance of the main pathogenic bacteria in the observation group were analyzed. The PCT and CRP/PA were compared between patients with Gram-negative bacteria and Gram-positive bacteria in the observation group. Univariate and multivariate Logistic regression analysis was used to explore the influencing factors of pathogenic bacteria of pulmonary infection after radical resection for lung squamous cell carcinoma. ROC curve was used to analyze the value of PCT, CRP/PA, and their combination in differentiating and diagnosing pathogenic bacteria of pulmonary infection after radical resection for lung squamous cell carcinoma. Results The PCT and CRP/PA in the observation group were higher than those in the control group (P < 0.05) . A total of 76 pathogenic bacteria were detected from 76 specimens in the observation group, including 55 Gram-negative bacteria (72.4%) and 21 Gram-positive bacteria (27.6%) . The resistance rate of Klebsiella pneumoniae and Acinetobacter baumannii to ampicillin was 100.0%. The resistance rate of Staphylococcus aureus to penicillin was 100.0%. The PCT and CRP/PA in patients with Gram-negative bacteria infection were higher than those in patients with Gram-positive bacteria infection (P < 0.05) . Univariate Logistic regression analysis showed that anesthesia duration, prophylactic use of antibiotics, PCT, CRP/PA were possible influencing factors for pathogenic bacteria of pulmonary infection after radical resection for lung squamous cell carcinoma (P < 0.05) . Multivariate Logistic regression analysis showed that PCT, CRP/PA were independent influencing factors for pathogenic bacteria of pulmonary infection after radical resection for lung squamous cell carcinoma (P < 0.05) . The results of ROC curve analysis showed that the AUC of PCT, CRP/PA, and their combination in differentiating and diagnosing pathogenic bacteria of pulmonary infection after radical resection for lung squamous cell carcinoma was 0.816, 0.839, 0.926 respectively. The AUC of their combination in differentiating and diagnosing pathogenic bacteria of pulmonary infection after radical resection for lung squamous cell carcinoma was greater than that of PCT, CRP/PA (P < 0.05) . Conclusion The PCT and CRP/PA are significantly increased in patients with pulmonary infection after radical resection for lung squamous cell carcinoma, Gram-negative bacteria is the mainly pathogenic bacteria. PCT and CRP/PA are independent influencing factors for pathogenic bacteria of pulmonary infection after radical resection for lung squamous cell carcinoma, and their combination has high value for differenting and diagnosing pulmonary infection after radical resection for lung squamous cell carcinoma, and this can provide direction for early clinical experience and medication.

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