16SrRNA基因检测在老年糖尿病烧伤脓毒症诊治中的价值
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摘要
目的探讨16SrRNA基因检测在老年糖尿病患者烧伤后脓毒症诊断治疗中的作用。方法采用回顾性分析的方法,选取2016年7月至2017年12月锦州市妇婴医院收治的80例老年糖尿病烧伤患者,均为疑似脓毒症,对患者血清标本的细菌培养检测结果与16SrRNA的PCR检测结果进行分析,同时观察PCR检测阳性与阴性、血培养阳性与阴性标本的白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、糖化血红蛋白(Hb A1c)、空腹血糖值(FPG)、餐后2小时血糖值(2 h PG)。结果 16SrRNA的PCR检测阳性率为41. 25%(33/80),明显高于血培养检测的23. 75%(19/80)(P <0. 05)。PCR检测时间平均为(4. 08±1. 14) h,明显少于血培养检测的(26. 72±11. 58) h(P<0. 05)。PCR与血培养阳性患者的白细胞计数(WBC)分别为(14. 85±2. 51)×109/L与(13. 84±2. 06)×109/L,明显低于阴性患者的(16. 17±2. 36)×10~9/L与(15. 81±2. 62)×10~9/L(P <0. 05),PCR与血培养阳性患者的IL-6、TNF-α、CRP、FPG、2h PG分别为(23. 48±5. 87) ng/L和(22. 94±5. 63) ng/L、(50. 67±6. 39) ng/L和(51. 47±6. 29) ng/L、(5. 02±1. 33) mg/L和(5. 14±1. 47) mg/L、(9. 14±1. 26) mmol/L和(9. 21±1. 02) mmol/L、(19. 77±2. 21) mmol/L和(19. 37±2. 46) mmol/L,明显高于阴性患者的(6. 84±2. 24) ng/L和(6. 27±2. 37) ng/L、(9. 11±3. 54) ng/L和(9. 37±2. 84) ng/L、(0. 92±0. 34) mg/L和(0. 85±0. 35) mg/L、(8. 44±1. 52) mmol/L和(8. 57±1. 13) mmol/L、(13. 15±2. 62) mmol/L和(12. 74±2. 16) mmol/L(P <0. 05),PCR与血培养阳性患者的Hb A1c分别为(8. 54±2. 16)%和(8. 53±2. 36)%,与阴性患者的(7. 59±2. 28)%和(7. 16±2. 72)%相比,差异无统计学意义(P> 0. 05)。结论老年糖尿病患者烧伤后检测血常规以及血清炎性因子指标能够为细菌感染提供预警信息,同时监测血糖水平变化也有一定的作用,对存在脓毒症危险性的患者,可以及时进行16SrRNA基因检测,能够在较短时间内确定是否发生感染,采取有效的治疗措施。
Objective To investigate role of 16 SrRNA gene detection in diagnosis and treatment of burn sepsis in elderly diabetic patients. Methods 80 elderly patients with diabetes burns admitted to Jinzhou Maternal and Child Hospital from July 2016 to December 2017 were retrospectively analyzed. All of them were suspected for sepsis thus bacterial culture of serum samples and PCR detection of 16 SrRNA. IL-6,CRP,TNF-α,hemoglobin( HbA1 c),fasting blood glucose( FPG),2 hours postprandial blood glucose( 2 h PG) were observed. Results The positive rate of PCR was 41. 25%( 33/80),significantly higher than that of blood culture 23. 75%( 19/80)( P < 0. 05). The average PCR time was( 4. 08 ± 1. 14) h,significantly less than that of blood culture( 26. 72 ± 11. 58) h( P < 0. 05). The WBC of patients with positive PCR( 14. 85 ± 2. 51) × 109/L and positive blood culture( 13. 84 ± 2. 06) × 10~9/L were lower than those with negative PCR( 16. 17 ± 2. 36) × 10~9/L and negative blood culture( 15. 81 ± 2. 62) × 109/L( P < 0. 05). IL-6,TNF-α,CRP,FPG and 2 h PG in patients with positive blood culture/PCR were [( 23. 48 ± 5. 87) ng/L and( 22. 94 ± 5. 63) ng/L,( 50. 67 ± 6. 39) ng/L and( 51. 47 ± 6. 29) ng/L,( 5. 02 ± 1. 33) mg/L and( 5. 14 ± 1. 47) mg/L,( 9. 14 ± 1. 26) mmol/L and( 9. 21 ± 1. 02) mmol/L,( 19. 77 ± 2. 21) mmol/L and( 19. 37 ± 2. 46) mmol/L],respectively,higher than those with negative blood culture/PCR results [( 6. 84 ± 2. 24) ng/L and( 6. 27 ± 2. 37) ng/L,( 9. 11 ± 3. 54) ng/L and( 9. 37 ± 2. 54) ng/L,( 0. 92 ± 0. 34) mg/L and( 0. 85 ± 0. 35) mg/L,( 8. 44 ± 1. 52) mmol/L and( 8. 57 ± 1. 13) mmol/L,( 13. 15 ± 2. 62)mmol/L and( 12. 74 ± 2. 16) mmol/L],( P < 0. 05). HbA1 c in patients with positive and negative PCR/blood culture was [( 8. 54 ± 2. 16) %and( 8. 53 ± 2. 36) ]vs. [( 7. 59 ± 2. 28) % and( 7. 16 ± 2. 72) % ],without significant difference( P > 0. 05). Conclusion For elderly diabetic patients after burn,monitoring serum inflammatory factors and blood sugar can provide early warning for bacterial infection. For those at risk of sepsis,16 SrRNA can provide instant help for infectious status diagnosis and guide early treatment.
Objective To investigate role of 16 SrRNA gene detection in diagnosis and treatment of burn sepsis in elderly diabetic patients. Methods 80 elderly patients with diabetes burns admitted to Jinzhou Maternal and Child Hospital from July 2016 to December 2017 were retrospectively analyzed. All of them were suspected for sepsis thus bacterial culture of serum samples and PCR detection of 16 SrRNA. IL-6,CRP,TNF-α,hemoglobin( HbA1 c),fasting blood glucose( FPG),2 hours postprandial blood glucose( 2 h PG) were observed. Results The positive rate of PCR was 41. 25%( 33/80),significantly higher than that of blood culture 23. 75%( 19/80)( P < 0. 05). The average PCR time was( 4. 08 ± 1. 14) h,significantly less than that of blood culture( 26. 72 ± 11. 58) h( P < 0. 05). The WBC of patients with positive PCR( 14. 85 ± 2. 51) × 109/L and positive blood culture( 13. 84 ± 2. 06) × 10~9/L were lower than those with negative PCR( 16. 17 ± 2. 36) × 10~9/L and negative blood culture( 15. 81 ± 2. 62) × 109/L( P < 0. 05). IL-6,TNF-α,CRP,FPG and 2 h PG in patients with positive blood culture/PCR were [( 23. 48 ± 5. 87) ng/L and( 22. 94 ± 5. 63) ng/L,( 50. 67 ± 6. 39) ng/L and( 51. 47 ± 6. 29) ng/L,( 5. 02 ± 1. 33) mg/L and( 5. 14 ± 1. 47) mg/L,( 9. 14 ± 1. 26) mmol/L and( 9. 21 ± 1. 02) mmol/L,( 19. 77 ± 2. 21) mmol/L and( 19. 37 ± 2. 46) mmol/L],respectively,higher than those with negative blood culture/PCR results [( 6. 84 ± 2. 24) ng/L and( 6. 27 ± 2. 37) ng/L,( 9. 11 ± 3. 54) ng/L and( 9. 37 ± 2. 54) ng/L,( 0. 92 ± 0. 34) mg/L and( 0. 85 ± 0. 35) mg/L,( 8. 44 ± 1. 52) mmol/L and( 8. 57 ± 1. 13) mmol/L,( 13. 15 ± 2. 62)mmol/L and( 12. 74 ± 2. 16) mmol/L],( P < 0. 05). HbA1 c in patients with positive and negative PCR/blood culture was [( 8. 54 ± 2. 16) %and( 8. 53 ± 2. 36) ]vs. [( 7. 59 ± 2. 28) % and( 7. 16 ± 2. 72) % ],without significant difference( P > 0. 05). Conclusion For elderly diabetic patients after burn,monitoring serum inflammatory factors and blood sugar can provide early warning for bacterial infection. For those at risk of sepsis,16 SrRNA can provide instant help for infectious status diagnosis and guide early treatment.
引文
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[9]李霞,王艳,唐一琳,等. 16SrRNA基因PCR扩增在尿路感染诊断中的应用进展[J].青岛大学医学院学报,2017,53(3):366-368.
[10]薛云平,温志立,付唆林.大黄对重症急性胰腺炎患者血清TNF-α、IL-1β、IL-6影响的临床研究[J].临床和实验医学杂志,2010,9(8):566-567.
[2]李明华,刘冬梅,刘进辉. 16SrRNA对于烧伤脓毒血症患者机体免疫调控的作用研究[J].系统医学,2018,3(2):34-37.
[3] World Health Organization Department of Noncommunicable Disease Surveillance. Definition,diagnosis and classification of diabetes mellitus and its complications[S]. 2 nd ed,1999:1-59.
[4]姚咏明,柴家科,盛志勇.烧伤脓毒症的诊断标准与防治[J].中华烧伤杂志,2003,19(2):65-66.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[6]王亚平,李文红.糖尿病合并脓毒症休克的危险因素分析及相关防治对策[J].世界最新医学信息文摘,2018,18(4):44-45.
[7]吕其军,史太阳,周芳,等. 16S rRNA基因检测在脓毒症早期诊断中的研究进展[J].中华医院感染学杂志,2016,26(10):2395-2397.
[8]曹敬荣,高世超,陈典典,等.基于细菌16S rRNA基因扩增临床不常见病原菌的价值[J].中国感染控制杂志,2016,15(4):222-226.
[9]李霞,王艳,唐一琳,等. 16SrRNA基因PCR扩增在尿路感染诊断中的应用进展[J].青岛大学医学院学报,2017,53(3):366-368.
[10]薛云平,温志立,付唆林.大黄对重症急性胰腺炎患者血清TNF-α、IL-1β、IL-6影响的临床研究[J].临床和实验医学杂志,2010,9(8):566-567.