【摘要】 目的 探讨神经外科重症患者耐碳青霉烯肠杆菌科细菌(carbapenem resistant enterobacteriaceae, CRE)感染发生危险因素及中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)、降钙素原(procalcitonin, PCT)、单核细胞趋化蛋白1(monocyte chemo-attractant protein-1,MCP-1)对感染的鉴别诊断价值。方法 选取我院神经外科重症感染患者122例作为研究对象，包括61例CRE感染、61例碳青霉烯敏感肠杆菌科细菌(carbapenem-sensitive enterobacteriaceae, CSE)感染，比较两组临床资料、NLR、PCT、MCP-1,Logistic分析CRE感染发生危险因素，Pearson分析NLR、PCT、MCP-1与急性生理与慢性健康评分(Acute Physiology and Chronic Health Score, APACHEⅡ评分)相关性，ROC分析NLR、PCT、MCP-1对神经外科重症患者CRE感染的鉴别诊断价值，KM曲线分析NLR、PCT、MCP-1高水平组、低水平组生存率。结果 两组抗生素药物应用、抗生素药物使用时间、碳青霉烯类使用、APACHEⅡ评分、NLR、PCT、MCP-1水平比较，差异有统计学意义(P<0.05);抗生素药物应用≥2联、抗生素药物使用时间>10 d、碳青霉烯类使用、APACHEⅡ评分≥20分、NLR、PCT、MCP-1高水平表达均为神经外科重症患者CRE感染的危险因素(P<0.05);神经外科重症CRE感染患者NLR、PCT、MCP-1与APACHEⅡ评分呈正相关关系(P<0.05);联合诊断CRE感染AUC值大于单一诊断(P<0.05);CRE感染患者NLR、PCT、MCP-1高水平组病死率高于低水平组(P<0.05)。结论 神经外科重症患者CRE感染受多种因素影响，其中NLR、PCT、MCP-1与病情程度密切相关，有助于CRE感染的鉴别诊断，临床可据此采取针对性干预措施，预防CRE感染的发生。更多还原

【Abstract】 Objective To investigate the risk factors of CRE infection and the value of neutrophil-to-lymphocyte ratio(NLR), procalcitonin(PCT), monocyte chemo-attractant protein-1(MCP-1) in the differential diagnosis of infection in critically ill patients undergoing neurosurgery. Methods In total, 122 patients with severe infection in Department of Neurosurgery of our hospital were selected as the research subjects, including 61 cases of carbapenem-resistant Enterobacteriaceae(CRE) infections and 61 cases of carbapenem-sensitive Enterobacteriaceae(CSE) infections. The clinical data, NLR, PCT, MCP-1 of the two groups were compared, and the risk factors of CRE infection were analyzed by Logistic regression. Pearson analysis was used to analyze the correlation between NLR, PCT, MCP-1 and acute physiology and chronic health(APACHEⅡ) score, and ROC was used to analyze the differential diagnosis value of NLR, PCT, and MCP-1 in critically ill patients with CRE infection undergoing neurosurgery. KM curve was used to analyze the survival rate of NLR, PCT, MCP-1 high-level group and low-level group. Results There was a statistically significant difference between two groups with respect to antibiotic drug application, duration of antibiotic drug use, carbapenem use, APACHEⅡ score, NLR, PCT and MCP-1 levels(P<0.05). The use of antibiotics ≥ 2 combinations, the duration of antibiotics use ≥ 10 days, the use of carbapenems, the APACHE Ⅱ score≥20, NLR, PCT, and MCP-1 high-level expression were all risk factors for CRE infection in critically ill patients undergoing neurosurgery(P<0.05). There was a positive correlation between NLR, PCT, MCP-1 and APACHEⅡ score in patients with severe CRE infection undergoing neurosurgery(P<0.05). AUC value of combined diagnosis of CRE infection was greater than single diagnosis(P<0.05). The mortality of patients with high levels of NLR, PCT and MCP-1 in CRE infection was higher than that in the low-level group(P<0.05). Conclusion CRE infection in critically ill patients undergoing neurosurgery is affected by multiple factors. Among them, NLR, PCT, and MCP-1 are closely related to the severity of the disease, which is conductive to the differential diagnosis of CRE infection. Therefore, targeted intervention measures can be taken accordingly to prevent the occurrence of CRE infection.更多还原