【摘要】 目的探究PCT等临床指标在鉴别肿瘤晚期患者感染性发热与肿瘤热中的意义,指导临床感染预防和治疗。方法收集52例肿瘤晚期感染性发热患者和29例肿瘤热患者临床资料,鉴定患者感染病原菌并分析主要病原菌耐药性。监测患者临床指标,并进行统计学分析。结果肿瘤晚期感染性发热患者年龄和体温分别为(45.21±9.67)岁和(38.98±4.40)℃,肿瘤热患者年龄和体温分别为(42.44±7.57)岁和(39.15±8.81)℃,差异均无统计学意义(t=1.415,0.408,P均>0.05)。肿瘤晚期感染性发热患者PCT、hs-CRP、WBC、NETU计数和NETU百分率(%)分别为(2.20±1.51)ng/ml、(92.44±15.46)mg/L、(14.64±3.06)×10~9/L、(8.62±1.42)×10~9/L和(72.96±5.67)%;肿瘤热患者分别为(0.19±0.09)ng/ml、(63.04±10.23)mg/L、(9.24±2.74)×10~9/L、(5.44±1.35)×10~9/L和(70.15±3.27)%,差异均有统计学意义(t=7.227、10.711、6.955、7.086和2.871,P均<0.05)。肿瘤晚期肺部感染发热患者PCT为(1.22±0.34)ng/ml,泌尿系感染为(0.79±0.15)ng/ml,腹腔感染为(0.52±0.10)ng/ml,血液感染为(3.34±0.31)ng/ml;肿瘤晚期感染发热患者共分离病原菌41株,其中包括肠球菌属、金黄色葡萄球菌、表皮葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、白色念珠菌、其他病原菌分别为10、9、8、6、3、2、1和2株。肠球菌属对克林霉素、庆大霉素、氨苄西林、环丙沙星的耐药率分别为70.00%、50.00%、40.00%和20.00%,对替加环素仍敏感。结论肿瘤晚期感染发热患者感染病原菌以肠球菌属为主,临床治疗中可首选替加环素。PCT等临床指标在鉴别肿瘤晚期患者感染性发热与肿瘤热中有指导意义。更多还原

【Abstract】 Objective To determine the significance of PCT and other clinical indices in differentiating patients with advanced cancer and an infection-related fever and patients with a tumor-related fever in order to guide the prevention and treatment of clinical infections. Methods Clinical data on 52 patients with advanced cancer and an infection-related fever and 29 patients with a tumor-related fever were collected to identify the pathogens infecting patients,and the drug resistance of the main pathogens were analyzed.Clinical indices were determined,and results were statistically analyzed. Results Patients with advanced cancer and an infection-related fever and patients with a tumor-related fever did not differ significantly in terms of age(t=1.415,P=0.168)or temperature(t=0.408,P=0.686).The level of PCT in patients with advanced cancer and an infection-related fever was 2.20±1.51 ng/ml,and the level in patients with a tumor-related fever was 0.19±0.09 ng/ml.The level of PCT differed significantly(t=7.227,P=0.000)according to a t-test.The level of hs-CRP in patients with advanced cancer and an infection-related fever was 92.44±15.46 mg/L,and the level in patients with a tumor-related fever was 63.04±10.23 mg/L.The level of hs-CRP differed significantly(t=10.711,P=0.000)according to a t-test.The WBC count in patients with advanced cancer and an infection-related fever was 14.64±3.06×10~9/L,and that count in patients with a tumor-related fever was 9.24±2.74×10~9/L.The WBC count differed significantly(t=6.955,P=0.000)according to a t-test.The NEUT count in patients with advanced cancer and an infection-related fever was 8.62±1.42×10~9/L,and the count in patients with a tumor-related fever was 5.44±1.35×10~9/L.The NEUT count differed significantly(t=7.086,P=0.000)according to a t-test.The percentage of NEUT in patients with advanced cancer and an infection-related fever was 72.96±5.67%,and the percentage in patients with a tumor-related fever was 70.15±3.27%.The percentage of NEUT differed significantly(t=2.871,P=0.000)according to a t-test.In the 52 patients with advanced cancer and an infection-related fever,the level of PCT was 1.22±0.34 ng/ml in patients with a pulmonary infection,0.79±0.15 ng/ml in patients with a urinary tract infection,0.52±0.10 ng/ml in patients with an intra-abdominal infection,and 3.34±0.31 ng/ml in patients with a blood infection.Forty-one strains of pathogens were isolated from 52 patients with advanced cancer and an infection-related fever,including Enterococcus(24.39%),Staphylococcus aureus(21.95%),S.epidermis(19.51%),Klebsiella pneumoniae(14.63%),Pseudomonas aeruginosa(7.32%),Escherichia coli(4.88%),Candida albicans(2.44%),and other pathogens(4.88%).The resistance of Enterococcus to clindamycin was 70.00%,its resistance to gentamicin was 50.00%,its resistance to ampicillin was 40.00%,and its resistance to ciprofloxacin was 20.00%,but it was sensitive to tigecycline. Conclusion The pathogen causing a fever in patients with advanced cancer was mainly Enterococcus,and tigecycline is the treatment of choice.PCT and other clinical indices are helpful guides with which to differentiate patients with advanced cancer and an infection-related fever and patients with a tumor-related fever.更多还原