中心静脉长期留置导管相关性感染的临床特征及炎症指标在其诊断中的价值

目的：探讨维持性血液透析患者中心静脉长期留置导管相关性感染（ CRI）的临床特征及联合多个炎症指标在其诊断中的作用。方法对33例中心静脉长期留置导管非感染患者和30例中心静脉长期留置CRI患者进行回顾性分析,比较分析两组临床资料及血常规、生化检查、血培养、降钙素原、C反应蛋白、红细胞沉降率等指标。结果 CRI与合并糖尿病、低血浆总蛋白、低血浆白蛋白、低血浆前蛋白相关（ P＜0.05或P＜0.01）,与性别、年龄、血肌酐、血红蛋白、白细胞计数无关（P＞0.05）。感染组中18例标本细菌培养阳性,共分离出8种病原菌,主要致病菌为金黄色葡萄球菌、表皮葡萄球菌。感染组和非感染组的降钙素原[（6.48±5.63）μg/L和（0.28±0.15）μg/L]、C反应蛋白[（60.45±26.50）mg/L和（3.87±3.77）mg/L]、红细胞沉降率[（68.36±31.67）mm/h和（27.6±16.60）mm/h],差别有显著性（P＜0.01或P＜0.05）。结论营养状态低下、糖尿病是中心静脉长期留置导管CRI的危险因素,CRI的主要致病菌为金黄色葡萄球菌和表皮葡萄球菌。降钙素原、C反应蛋白、红细胞沉降率的升高均能在一定程度上反映CRI的发生,联合使用多个炎症指标,尤其是降钙素原在CRI的早诊断中发挥重要作用。

Clinical features Of catheter-related infectiOn and diagnOsis value Of multiple inflammatOry markers in hemOdialysis patients with lOng term central venOus catheter

Objective To investigate clinical features of catheter-related infection and the diagnosis value of multiple inflammatory markers in hemodialysis patients with long term central venous catheter. MethOd The clinical general data of thirty-three cases without CRI and thirty cases with CRI in hemodialysis patients with long term central ve-nous catheter were analyzed retrospectively. Routine blood test,biochemical examination, blood culture,serum lev-els of procalcitonin（ PCT） ,C-reactive protein（ CRP） ,erythrocyte sedimentation rate （ ESR） , were compared. Result CRI was related to the combination with diabetes,low plasma total albumin,low plasma albumin and low plasma pre albumin（P〈0. 05）,while was not related to sex,age,white blood cell count,hemoglobin,serum creatinine. Bacterial culture of eighteen samples turned out to be positive,and eight kinds of pathogenic bacteria were isolated, Staphylo-coccus aureus and Staphylococcus epidermidis were the main pathogenic bacteria. There was significantly statistical difference between CRI group and non-CRI group on values of PCT[（6. 48±5. 63）μg/L vs （0. 28±0. 15）μg/L], CRP[（60. 45±26. 50）mg/L vs （3. 87±3. 77）mg/L],ESR[（68. 36±31. 67）mm/h vs （27. 6±16. 60）mm/h]（P〈0. 05 or P〈0. 01）. COnclusiOn Combination of diabetes and low nutrition state are the related risk factors of CRI. Staphylococcus aureus and staphylococcus epidermidis are the main pathogenic bacteria of CRI. To some extense,the increase of PCT, CRP and ESR may show the occurrence of CRI and multiple inflammatory markers,especially PCT may play an important role in early diagnosis of CRI better than CRP and ESR.