呼吸机相关性肺炎患者血浆内毒素的诊断及预后分析
摘要
目的探讨血浆内毒素的检测在呼吸机相关性肺炎患者中的诊断价值及对其预后的评估作用。方法选择我院急诊科ICU呼吸机相关性肺炎患者52例,根据内毒素检测结果,将其分为内毒素检测阳性组29例(A组)组及内毒素检测阴性组23例(B组);采用鲎试剂的显色基质法,检测血浆内毒素含量,以≥0.4EU/mL为阳性结果,分析比较两组的临床指标。结果 A组合并真菌感染及肝功能不全患者的比率显著高于B组(P<0.05);两组合并脓毒血症、多脏器功能不全(MODS)、急性呼吸窘迫综合征(ARDS)、弥漫性血管内凝血(DIC)等指标比较,差异无统计学意义(P>0.05);两组病死率比较,差异无统计学意义(P>0.05)。结论血浆内毒素检测可能不是作为诊断革兰氏阴性菌呼吸机相关性肺炎的有效诊断指标,对其预后评估无明显作用。
引文
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[18]Elin R J,Robinson R A,Levine A S.Lack of clinical usefulness of the limulus test in the diagnosis of endotoxemia[J].N Engl J Med,1975,293(11):521-524.
[19]Casey L C,Balk R A,Bone R C.Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome[J].Ann Intern Med,1993,119(8):771-778.
[20]Endo S,Inada K,Inoue Y,et al.Two types of septic shock classified by the plasma levels of cytokines and endotoxin[J].Circ Shock,1992,38(4):264-274.
[21]Dofferhoff A S M,Bom V J J,de Vries-Hospers H G,et al.Patterns of cytokines,plasma endotoxin,plasminogen activator inhibitor,and acute phase proteins during the treatment of severe sepsis in humans[J].Crit Care Med 1992,20(2):185-192.
[2]de Jaeger A,Litalien C,Lacroix J,et al.Protected specimen brush or bronchialveolar lavage to diagnose bacterial nosocomial pneumonia in ventilated adults:a meta-analysis[J].Crit Care Med 1999,27(3):2548-2560.
[3]O'Horo J C,Thompson D,Safdar N.Is the gram stain useful in the microbiologic diagnosis of VAP:a meta-analysis[J].Clin Infect Dis,2012,55(4):551-561.
[4]American Thoracic Society,Infectious Diseases Society of America.Guidelines for the management of adults with hospitalacquired, ventilator-associated, andhealthcare-associated pneumonia[J].Am J Respir Crit Care Med,2005,171(9):388-416.
[5]王华彬,王萍,罗开源,等.降钙素原和内毒素定量测定在小儿肺炎中的诊断价值[J].赣南医学院学报,2015,35(3):388-389.
[6]韩金霞,司进,周锦云,等.血浆细菌内毒素检测对下呼吸道G-菌感染诊治的临床意义[J].天津医药,2004,32(3):177-179.
[7]代华平,王辰,黄秀霞,等.肺部感染时血浆内毒素水平的变化[J].中国实用内科杂志,1996,16(9):541-542.
[8]Hurley J C.Concordance of endotoxemia with gram-negative bacteremia in patients with gram-negative sepsis:a metaanalysis[J].J Clin Microbiol,1994,32(5):2120-2127.
[9]Van Deventer S J H,Buller H R,Cate J W,et al.Endotoxaemia:an early predictor of septicaemia in febrile patients[J].Lancet 1988,1(8586):605-609.
[10]Pugin J,Auckenthaler R,Delaspre O,et al.Rapid diagnosis of gram negative pneumonia by assay of endotoxin in bronchoalveolarlavage fluid[J].Thorax,1992,47(7):547-549.
[11]Flanagan P G,Jackson S K,Findlay G.Diagnosis of gram negative,ventilator associated pneumonia by assaying endotoxin in bronchial lavage fluid[J].J Clin Pathol,2001,54(2):107-110.
[12]Roslansky P F,Novitsky T J.Sensitivity of Limulus amebocytelysate(LAL)to LAL reactive glucans[J].J Clin Microbiol,1991,29(3):2477-2483.
[13]Flegel W A,Wolpl A,Mannel D N,et al.Inhibition of endotoxin-induced activation of human monocytes by human lipoproteins[J].Infect Immun,1989,57(5):2237-245.
[14]Brandtzaeg P,Kierulf P,Gaustad P,et al.Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease[J].J Infect Dis,1989,159(2):195-204.
[15]Butler T,Levin J,Linh N N,et al.Quantitative blood cultures and detection of endotoxin in the cerebrospinal fluid of patients with meningitis[J].J Infect Dis,1976,133(6):493-499.
[16] Watt G,Padre L P,Tuazon M,et al.Limulus lysate positivity and Herxheimer-like reactions in leptospirosis:aplacebo controlled study[J].J Infect Dis,1990,2(162):564-567.
[17]Stumacher R J,Kovnat M J,McCabe W R.Limitations of the usefulness of the limulus assay for endotoxin[J].N Engl J Med,1973,288(24):1261-1264.
[18]Elin R J,Robinson R A,Levine A S.Lack of clinical usefulness of the limulus test in the diagnosis of endotoxemia[J].N Engl J Med,1975,293(11):521-524.
[19]Casey L C,Balk R A,Bone R C.Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome[J].Ann Intern Med,1993,119(8):771-778.
[20]Endo S,Inada K,Inoue Y,et al.Two types of septic shock classified by the plasma levels of cytokines and endotoxin[J].Circ Shock,1992,38(4):264-274.
[21]Dofferhoff A S M,Bom V J J,de Vries-Hospers H G,et al.Patterns of cytokines,plasma endotoxin,plasminogen activator inhibitor,and acute phase proteins during the treatment of severe sepsis in humans[J].Crit Care Med 1992,20(2):185-192.