【摘要】 目的:通过检测急性脑卒中相关性肺炎(SAP)患者血清降钙素原(PCT)以及C反应蛋白/血清白蛋白(CRP/ALB)比值,分析SAP患者病原体分布以及PCT和CRP/ALB比值的诊断价值。方法:收集将2017年1月至2019年11月期间于本院接受诊治的脑卒中合并相关性肺炎患者368例,作为观察组,以痰培养结果阳性和阴性为依据,进行分组,痰培养阳性组211例,痰培养阴性组157例;以同期以脑卒中住院,但未发生感染的患者330例,作为对照组,回顾性分析各组患者的临床资料,血清PCT和CRP/ALB比值,痰培养结果以及病原体血清学检测结果。结果:与对照组比较,观察组患者PCT和CRP/ALB显著性升高,有统计学差异(0.73±0.22vs0.07±0.03; 0.87±0.23vs0.48±0.19 P <0.05);368例SAP患者中,211例痰培养结果阳性,占57.3%,其中79例为革兰阳性菌,占37.3%,91例为革兰阴性杆菌占43.0%、17例为真菌,占8.2%,其他24例,占11.4%,主要包括大肠埃希菌、肺炎克雷伯杆菌、鲍曼不动杆菌、金黄色葡萄球菌、肺炎链球菌、白色念珠菌、热带念珠菌、光滑念珠菌等;在观察组患者中,痰细菌培养阳性组患者血清PCT和CRP/ALB显著高于阴性组,有统计学差异(1.19±0.34vs0.62±0.27; 2.19±0.45vs1.49±0.28 P <0.05);通过检测观察组患者血清学鉴定结果,发现细菌感染243例、占66.3%,病毒感染56例、占15.2%,支原体感染43例,占11.7%,其他26例,占7.1%;细菌感染组血清PCT水平显著高于支原体和病毒感染组,各组患者CRP/ALB均升高,但细菌感染组更明显,有统计学差异(1.26±0.28vs0.51±0.14vs 0.12±0.03; 2.37±0.69vs1.79±0.56vs0.38±0.24 P<0.05)。结论:急性脑卒中相关性肺炎(SAP)患者常见病原体依次是细菌、病毒和真菌,检测血清PCT和CRP/ALB比值有助于病原学诊断,指导临床治疗。更多还原

【Abstract】 Objective: To analyze diagnostic value on etiological classification for stroke associated pneumonia( SAP),by detection on the PCT and CRP/Alb ratio in serum of patients suffering from stroke. Methods368 patients suffering from SAP hospitalized from January 2017 to November 2019 were selected,and then,based on the results of sputum culture,were divided into the positive group( n = 211) and the negative group( n = 157). The patients who were hospitalized with stroke but without infection were made the control group( n= 157). The clinical data of each group were analyzed retrospectively,and the PCT and CRP/Alb ratio in serum,the results of sputum culture and the serological examination of the pathogen as well. Results: Compared with the control group,the PCT and CRP/Alb ratio in serum of the patients in the observation group were significantly elevated( 0.73±0.22 vs0.07±0.03; 0.87±0.23 vs0.48±0.19 P <0.05). Among the 368 patients suffering from SAP,211( 57.3%) sputum cultures were positive. Gram-positive bacteria were 79( 37.3%),Gram-negative bacteria,91( 43.0%),fungus,17( 8.2%),the rest of sputum cultures,24( 11.4%),mainly including Escherichia coli,Klebsiella Pneumoniae,acinetobacter Bowman,Staphylococcus Aureus,Streptococcus Pneumoniae,Candida Albicans,Candida Tropicalis,Candida Glabrata,et al. The PCT and CRP/Alb ratio in serum of the patients the positive group of sputum bacteria culture were higher than the negative group( 1.19±0.34 vs0.62±0.27; 2.19±0.45 vs1.49 ± 0.28 P < 0.05). After examining the serological identification results of the patients in the observation group,243 cases( 66.3%) had bacterial infection,56 cases( 15.2%) had viral infection,43 cases( 11.7%) had mycoplasma infection,26( 7.1%) of the rest were found with other infections. The PCT and CRP/Alb ratio in serum of the patients of the bacterial infection group were significantly higher than the viral infection group and the mycoplasma infection group( 1.26 ±0.28 vs0.51 ±0.14 vs 0.12 ± 0.03; 2.37±0.69 vs1.79±0.56 vs0.38±0.24 P <0.05). Conclusion: The most common pathogens in patients with SAP were bacteria,virus,mycoplasma and fungi. Serum CRP/Alb ratio has a certain diagnostic value on etiological classification in predicting the occurrence of SAP,It is helpful to the etiological diagnosis and it guides the clinical treatment.更多还原