恶性淋巴瘤PICC导管相关性血流感染患者NLR、D-二聚体等因子的表达及其意义-现代医学

恶性淋巴瘤PICC导管相关性血流感染患者NLR、D-二聚体等因子的表达及其意义

单位：1. 无锡市第二人民医院肿瘤科, 江苏无锡 214002;
2. 无锡市第二人民医院血液科, 江苏无锡 214002

关键词：经外周静脉置入中心静脉导管导管相关性血流感染恶性淋巴瘤病原菌分布 D-二聚体中性粒细胞淋巴细胞数比值

分类号：R63

出版年·卷·期（页码）：2018·46·第十期（1098-1102）

摘要：

目的：分析恶性淋巴瘤患者经外周静脉置入中心静脉导管（PICC）导管相关性血流感染的病原菌分布，探究患者中性粒细胞淋巴细胞数比值（NLR）、D-二聚体等因子的表达及其意义。方法：选取我院收治的恶性淋巴瘤患者108例，按是否发生PICC导管相关性血流感染分为感染组28例和非感染组80例，对感染组样本进行病原体培养统计病原菌分布；比较两组患者NLR、D-二聚体、血栓调节蛋白（TM）3项指标，通过受试者工作特征曲线（ROC曲线）评价3项指标对临床诊断的价值。结果：感染组细菌培养共检出病原菌32株，包括革兰阳性菌20株（其中金黄色葡萄球菌共14株）、革兰阴性菌11株（以肺炎克雷伯菌为主）及真菌1株。感染组患者NLR、D-二聚体和TM值均显著升高（P<0.05）；3项血液因子的诊断效能均较高。结论：恶性淋巴瘤患者PICC导管相关性血流感染病原菌以革兰阳性菌为主，感染患者NLR、D-二聚体、TM均显著升高，3项指标均具有诊断价值，NLR升高表明患者存在全身细菌性炎症反应。

Objective:To analyze the etiological distribution of peripherally inserted central catheter (PICC) -related blood flow infection, and to explore the expression and significance of neutrophil-lymphocyte ratio (NLR), D-Dimer and other factors in patients with malignant lymphoma. Methods:One hundred and eight cases of malignant lymphoma treated in our hospital were enrolled in this study.The patients were divided into infection group (n=28) and non-infection group (n=80). The pathogenic bacteria were cultured and the distribution of pathogenic bacteria was analyzed in the infection group. The levels of NLR, D-Dimer and thrombomodulin (TM) were compared between the two groups. The diagnostic value of the three indexes was evaluated by ROC curve.Results:Thirty-two strains of pathogenic bacteria were detected in blood culture specimens, which included 20 strains of gram-positive bacteria (14 strains of Staphylococcus aureus), 11 strains of gram-negative bacteria (mainly Klebsiella pneumoniae) and 1 strain of fungus. The levels of NLR, D-Dimer and TM in the infection group were significantly elevated (P<0.05), and the diagnostic efficiency of the three indicators was higher. Conclusion:Gram-positive bacteria are the main pathogenic bacteria inPICC-related blood flow infection in patients with malignant lymphoma.The levels of NLR, D-Two and TM are significantly increased in patients with infection, which plays an important role in the diagnosis. NLR elevation indicates that there is a bacterial inflammatory reaction of the whole body.

参考文献：

[1] 吴永芳,许春伟,韩鸿雁,等.443例恶性淋巴瘤临床病理特征分析[J].临床与病理杂志,2015,35(7):1268-1275.
[2] 田晓琳,杨臻,王建英,等.恶性淋巴瘤的近现代中医诊疗现状[J].世界中医药,2016,11(8):1644-1648.
[3] 王冬云,史健,李艳荣,等.恶性肿瘤PICC患者血清CRP及PCT和SAA的水平与感染关系研究[J].中华医院感染学杂志,2017,27(16):3631-3634.
[4] 邓庆梅,李飞,赵华,等.肿瘤并发病原菌感染患者NLR的临床意义[J].安徽医学,2016,37(8):962-966.
[5] 邱国超,李旸,饶智国.恶性肿瘤患者PICC相关血栓形成危险因素分析[J].现代肿瘤医学,2015,23(12):1741-1743.
[6] SECKOLD T L,WALKER S,DWYER T.A comparison of silicone and polyurethane PICC lines and postinsertion complication rates:a systematic review[J].J Vasc Access,2015,16(3):167-177.
[7] 赵爽爽,王辉,李莉,等.PICC对恶性肿瘤患者血浆D-二聚体水平的影响[J].现代肿瘤医学,2016,24(20):3273-3276.
[8] 吴清霞,林海燕,林白浪,等.经外周静脉置入中心静脉导管置管患者医院感染病原学特征与干预效果[J].中华医院感染学杂志,2016,26(3):692-694.
[9] VERBEKE J,PICCART K,PIEPERS S,et al.Somatic cell count and milk neutrophil viability of dairy heifers with specific CXCR1 genotypes following experimental intramammary infection with Staphylococcus chromogenes originating from milk[J].Vet J,2015,204(3):322-326.
[10] COSTA A R D,OGUTI B,ASHBY A,et al.G423 Service evaluation of the management of osteoarticular infection over 8 years in a single centre[J].Arch Dis Chil,2015,100(Suppl 3):A175-A175.
[11] 原娜,王磊,武雪亮.凝血酶原片段1+2、血浆D-二聚体预测恶性肿瘤PICC相关性静脉血栓的研究[J].山西医科大学学报,2017,48(7):694-697.
[12] 王亚丽,张丽军,刘晔璇,等.急性白血病患者PICC置管相关性感染因素及对策分析[J].临床与病理杂志,2016,36(6):756-760.
[13] 徐洪恩,贾勇士,吴树强,等.老年肿瘤患者PICC导管相关性感染的影响因素分析及干预评价[J].中华全科医学,2016,14(4):536-539.
[14] GAO S Q,HUANG L D,DAI R J,et al.Neutrophil-lymphocyte ratio:a controversial marker in predicting Crohn's disease severity[J].Int J Clin Exp Pathol,2015,8(11):14779.
[15] VALBOUSQUET-SCHNEIDER L Jr,DURON S,ARNAUD F X,et al.Evaluation of PICC complications in orthopedic inpatients with bone infection for long-term intravenous antibiotics therapy[J].J Vasc Access,2015,16(4):299.
[16] 孟月燕,王鲁杰,胥桂英,等.经外周置入中心静脉导管相关性血流感染调查分析[J].中华医院感染学杂志,2015,25(18):4211-4213.
[17] 郭家勋.标准化配置换药包预防骨科PICC导管相关性感染的研究[J].实用临床医药杂志,2016,20(8):64-66.
[18] 陈静,杨双.中心血管通路装置置管前评估表在淋巴瘤化疗患者中的应用[J].护士进修杂志,2016,31(1):43-44.
[19] 原娜,王磊,王喆,等.血栓调节蛋白、血浆D-二聚体对恶性肿瘤经外周静脉穿刺中心静脉置管相关性静脉血栓的影响[J].中国医师进修杂志,2017,40(6):542-546.
[20] 刘艳慧,张茵,翟亚平,等.血液肿瘤患者PICC相关性静脉血栓临床分析[J].血栓与止血学,2016,22(4):433-435.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录