目的:将心脏植入电子装置(cardiac implantable electronic device, CIED)囊袋微生物培养阳性但却不合并任何临床感染症状(囊袋周围皮肤出现红肿热痛、破溃、化脓等症状可以确诊囊袋感染或CIED相关的感染性心内膜炎)的情况定义为无症状囊袋感染,即亚临床囊袋感染。本研究旨在探索无症状囊袋感染的危险因素、预后以及炎症因子水平与无症状CIED囊袋感染之间的关系,寻求早期识别亚临床囊袋感染的方法。方法:连续入选2011年1月至2014年10月在卫生部北京医院及阜外医院行CIED的患者一共179例(排除临床确诊囊袋感染或植入性心脏电子装置相关感染性心内膜炎患者),留取血培养和囊袋组织培养,收集相关临床资料,相关结果进行单因素及多因素回归分析。并对病人进行为期60个月的随访。在上述病人中随机抽取108例行5种炎性因子(CRP、IL-1、IL-6、MCP、PCT)测定,分析其中囊袋培养阴性组与囊袋培养阳性组的炎症因子的差异。抽取40例正常人的炎症因子与上述患者进行比较。结果:179例行心脏植入电子装置更换的患者,血培养均为阴性,所有入选患者中,囊袋组织培养结果阳性25例(14.0%)。检出率最高的致病菌为凝固酶阴性葡萄球菌,共19例(76.0%)。多因素Logistic回归分析发现男性(P = 0.001, OR = 14.001, 95%CI: 2.825~69.401),术前三月内抗生素使用大于10天(P = 0.002, OR = 27.935, 95%CI: 3.446~226.437),服用抗血小板药物(P = 0.008, OR = 3.761, 95%CI: 1.406~10.058)为无症状亚临床囊袋感染的独立危险因素。囊袋培养阳性组随访期内有4%的患者(1人/25人)因囊袋感染返院清创,阴性组无人报告临床囊袋感染。CIED更换患者的炎性因子的数值(CRP、IL-1、IL-6、MCP、PCT)明显高于正常人对照组(P = 0.001),囊袋培养阳性的患者与囊袋培养阴性的患者的炎性因子之间不存在显著差异。剔除基础疾病后的亚组分析中,CIED更换患者的炎症因子仍明显高于正常对照组,囊袋培养阳性与囊袋培养阴性的患者之间炎性因子仍未见显著差异。结论:临床上无感染表现的CIED植入患者中,无症状囊袋感染发生率约14.0%,其独立的危险因素是男性,长期服用抗血小板药物与术前3月内使用抗生素大于10天。无症状囊袋感染的患者迟发临床囊袋感染的几率为4%。CIED更换者的炎性因子整体水平明显升高,提示患者可能处于炎症反应激活的状态,但利用炎性因子检测协助诊断CIED亚临床感染目前证据尚不充分。 Objective: To investigate the risk factors, prognosis and the predictive value of 5 different inflammatory factors in CIED associated subclinical generator pocket infections (asymptomatic infection also called subclinical. Methods: A total of 179 patients undergoing replacement of CIED (cardiac implanted electronic devices) in Beijing hospital and Fuwai Hospital between January 2011 and October 2014 were recruited. Microbiological cultures of blood and generator pockets were consecutively obtained. Patients with clinical evidence of CIED infection were excluded. Patients were regularly followed up 60 months after discharge. Univariate and multivariable analyses were performed to identify significant risk factors for positive generator pockets culture patients. Five different inflammatory factors (CRP, IL-1, IL-6, MCP, PCT) were measured in 108 patients randomly selected from patients above, and the differences of inflammatory factors were analyzed between patients with positive pocket tissue cultures and patients with negative pocket tissue cultures. The inflammatory factors of 40 normal people were compared with the patients above too. Results: All blood cultures of the 179 patients were negative. Positive cultures from the generator pocket were found in 25 patients (14.0%). The most common bacteria isolated were coagulase negative staphylococci (76.0%). A multivariable logistic regression identified that male sex (P = 0.001, OR = 14.001, 95%CI: 2.825~69.401), antibiotic use 3 months before implantation (P = 0.002, OR = 27.935, 95%CI: 3.446~226.437), antiplatelet therapy (P = 0.008, OR = 3.761, 95%CI: 1.406~10.058) as independent risk factors for asymptomatic bacterial colonization of generator pockets. 4% patients with positive pocket culture showed clinical sign of infection during 60 months follow-up, while none of patients with negative pocket culture reported any sign of CIED relevant infections. Significant difference in inflammatory factors (including CRP, IL-1, IL-6, MCP, PCT) had been identified between patients who replaced CIED and the normal control group, however there was no relevance between inflammatory factors and generator pocket cultures even when all the fundamental clinical complications were excluded. Conclusion: 14.0% of patients undergoing CIED replacement have an asymptomatic bacterial colonization of generator pockets. Independent factors for positive pockets culture is male sex, antibiotic use 3 months before implantation, antiplatelet therapy 0.4% of patients with positive pocket culture develop clinical CIED infection. Inflammatory factors are significantly elevated in patients undergoing CIED replacement suggesting a strong inflammatory reaction in those patients, however, there is not sufficient evidence indicating predictive value of inflammatory factors in early diagnosis of subclinical CIED infections.
目的:将心脏植入电子装置(cardiac implantable electronic device, CIED)囊袋微生物培养阳性但却不合并任何临床感染症状(囊袋周围皮肤出现红肿热痛、破溃、化脓等症状可以确诊囊袋感染或CIED相关的感染性心内膜炎)的情况定义为无症状囊袋感染,即亚临床囊袋感染。本研究旨在探索无症状囊袋感染的危险因素、预后以及炎症因子水平与无症状CIED囊袋感染之间的关系,寻求早期识别亚临床囊袋感染的方法。方法:连续入选2011年1月至2014年10月在卫生部北京医院及阜外医院行CIED的患者一共179例(排除临床确诊囊袋感染或植入性心脏电子装置相关感染性心内膜炎患者),留取血培养和囊袋组织培养,收集相关临床资料,相关结果进行单因素及多因素回归分析。并对病人进行为期60个月的随访。在上述病人中随机抽取108例行5种炎性因子(CRP、IL-1、IL-6、MCP、PCT)测定,分析其中囊袋培养阴性组与囊袋培养阳性组的炎症因子的差异。抽取40例正常人的炎症因子与上述患者进行比较。结果:179例行心脏植入电子装置更换的患者,血培养均为阴性,所有入选患者中,囊袋组织培养结果阳性25例(14.0%)。检出率最高的致病菌为凝固酶阴性葡萄球菌,共19例(76.0%)。多因素Logistic回归分析发现男性(P = 0.001, OR = 14.001, 95%CI: 2.825~69.401),术前三月内抗生素使用大于10天(P = 0.002, OR = 27.935, 95%CI: 3.446~226.437),服用抗血小板药物(P = 0.008, OR = 3.761, 95%CI: 1.406~10.058)为无症状亚临床囊袋感染的独立危险因素。囊袋培养阳性组随访期内有4%的患者(1人/25人)因囊袋感染返院清创,阴性组无人报告临床囊袋感染。CIED更换患者的炎性因子的数值(CRP、IL-1、IL-6、MCP、PCT)明显高于正常人对照组(P = 0.001),囊袋培养阳性的患者与囊袋培养阴性的患者的炎性因子之间不存在显著差异。剔除基础疾病后的亚组分析中,CIED更换患者的炎症因子仍明显高于正常对照组,囊袋培养阳性与囊袋培养阴性的患者之间炎性因子仍未见显著差异。结论:临床上无感染表现的CIED植入患者中,无症状囊袋感染发生率约14.0%,其独立的危险因素是男性,长期服用抗血小板药物与术前3月内使用抗生素大于10天。无症状囊袋感染的患者迟发临床囊袋感染的几率为4%。CIED更换者的炎性因子整体水平明显升高,提示患者可能处于炎症反应激活的状态,但利用炎性因子检测协助诊断CIED亚临床感染目前证据尚不充分。
植入型心脏电子装置,亚临床感染,危险因素,预后,炎症因子
Wen Cui1, Junpeng Liu2, Xu Gao2, Zhilei Wang2, Xin Jin2, Sujuan Wu2, Gaofeng Lin3, Jiabin Tong2, Jiefu Yang2, Tong Zou2*
1Department of Cardiology, National Center for Cardiovascular Diseases Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
2Department of Cardiology, Beijing Hospital, Beijing
3Graduate School of Peking Union Medical College, Beijing
Received: Jan. 25th, 2021; accepted: Feb. 9th, 2021; published: Feb. 26th, 2021
Objective: To investigate the risk factors, prognosis and the predictive value of 5 different inflammatory factors in CIED associated subclinical generator pocket infections (asymptomatic infection also called subclinical. Methods: A total of 179 patients undergoing replacement of CIED (cardiac implanted electronic devices) in Beijing hospital and Fuwai Hospital between January 2011 and October 2014 were recruited. Microbiological cultures of blood and generator pockets were consecutively obtained. Patients with clinical evidence of CIED infection were excluded. Patients were regularly followed up 60 months after discharge. Univariate and multivariable analyses were performed to identify significant risk factors for positive generator pockets culture patients. Five different inflammatory factors (CRP, IL-1, IL-6, MCP, PCT) were measured in 108 patients randomly selected from patients above, and the differences of inflammatory factors were analyzed between patients with positive pocket tissue cultures and patients with negative pocket tissue cultures. The inflammatory factors of 40 normal people were compared with the patients above too. Results: All blood cultures of the 179 patients were negative. Positive cultures from the generator pocket were found in 25 patients (14.0%). The most common bacteria isolated were coagulase negative staphylococci (76.0%). A multivariable logistic regression identified that male sex (P = 0.001, OR = 14.001, 95%CI: 2.825~69.401), antibiotic use 3 months before implantation (P = 0.002, OR = 27.935, 95%CI: 3.446~226.437), antiplatelet therapy (P = 0.008, OR = 3.761, 95%CI: 1.406~10.058) as independent risk factors for asymptomatic bacterial colonization of generator pockets. 4% patients with positive pocket culture showed clinical sign of infection during 60 months follow-up, while none of patients with negative pocket culture reported any sign of CIED relevant infections. Significant difference in inflammatory factors (including CRP, IL-1, IL-6, MCP, PCT) had been identified between patients who replaced CIED and the normal control group, however there was no relevance between inflammatory factors and generator pocket cultures even when all the fundamental clinical complications were excluded. Conclusion: 14.0% of patients undergoing CIED replacement have an asymptomatic bacterial colonization of generator pockets. Independent factors for positive pockets culture is male sex, antibiotic use 3 months before implantation, antiplatelet therapy 0.4% of patients with positive pocket culture develop clinical CIED infection. Inflammatory factors are significantly elevated in patients undergoing CIED replacement suggesting a strong inflammatory reaction in those patients, however, there is not sufficient evidence indicating predictive value of inflammatory factors in early diagnosis of subclinical CIED infections.
Keywords:Cardiac Implantable Electronic Device, Subclinical Infections, Risk Factor, Prognosis, Inflammatory Factor
Copyright © 2021 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
随着国内外人口的老龄化的发展,置入CIED (cardiac implanted electronic devices,心脏置入型电子装置)的患者逐年增多,并呈现出合并症多临床情况复杂的特点 [
Vitek-2 Compact细菌全自动鉴定/药敏仪(法国梅里埃公司);电热恒温培养箱(上海博迅实业有限公司医疗设备厂);TQZ-312型台式恒温摇床(上海精宏实验设备有限公司)。
琼脂糖、无水氯化钙、氨苄西林、溴乙啶、溴酚蓝等常用分子生物学试剂(上海Sangon公司)。
2011年1月~2014年10月期间于卫生部北京医院及阜外医院行CIED更换术的患者。入选标准:1. 年满18周岁;2. 既往植入CIED,目前需要更换;3. 预期生存时间1年以上;4. 完全理解本研究并取得知情同意的患者。排除标准:1. 患者拒绝;2. 临床症状上可以确诊囊袋感染患者;3. 可以诊断CIED相关性感染性心内膜炎的患者。
对于符合入选标准的患者,记录其临床资料:年龄、性别、起搏器植入指征、起搏器更换原因、起搏器植入时间,更换频次,临时起搏器使用,起搏器类型、临床合并症及既往史:是否合并慢性心脏病(冠心病或心功能不全,NYHA分级III、IV级;长期高血压病需要3种及以上药物控制)、心房颤动、糖尿病、是否合并肾功能不全(eGFR < 60 ml/min/1.73 m2)、慢性阻塞性肺疾病病、免疫抑制状态(使用激素或免疫抑制药物)、合并恶性肿瘤、应用抗凝抗血小板药物、近期抗生素使用(手术前3月内各种原因使用抗生素超过10天)。定期随访至术后5年,随访方式为门诊随访或电话咨询,记录患者是否出现临床囊袋感染征象或CIED相关感染性心内膜炎,是否因CIED感染进行清创、导线拔除、外科手术,或因CIED感染死亡。
抽取入选受试者的静脉血10 mL,立即送微生物检查实验室行细菌培养检测。抽取入选受试者静脉血4 mL,同时送生化实验室行炎症因子检测。于CEID更换术中,留取囊袋标本5 g,立即送往微生物检查实验室进行细菌培养:将囊袋标本无菌条件下研磨后接种血琼脂培养基、中国蓝培养基和巧克力培养基,并同时接种肉汤进行增菌,于35℃孵育箱观察24小时,并将增菌后肉汤转种血琼脂培养基,35℃孵育箱中培养24小时后观察结果。
数据采用SPSS18.0软件包进行统计分析,计量资料用(x ± s)表示;单因素分析用独立样本t检验;多样本均数比较采用单因素方差分析和H检验;计数资料间比较采用χ2检验;多因素分析采用Logistic回归分析,P < 0.05认为差异有统计学意义。
入选患者基本特征:本次试验共入选179例需行起搏器更换患者,男性101例,女性78例,年龄21至96岁,平均年龄(74.10 ± 12.46)岁,起搏器植入时间最短4个月,最长372个月,平均植入时间(114.78 ± 47.22)个月。更换CIED的原因主要包括:电池耗竭171例(95.5%),起搏器升级6例(3.4%),电极调整术2例(1.1%)。单腔起搏器47例(26.3%),双腔起搏器例129 (72.1 %),ICD (Implanted cardiac defibrillator, 置入型心脏除颤器) 2例(1.1%),CRT (Cardiac resynchronization therapy心脏再同步治疗器) 1例(0.6%)。首次更换的患者145例(81.0%),第2次者25例(14.0%),第3次者9例(5%)。使用过临时起搏器的患者8例(4.5%)。其他基本特征见表1及表2。
总数为179名的入选患者中,囊袋组织培养阳性者25例(13.9%)。检出率最高的致病菌为凝固酶阴性葡萄球菌,一共19例(76.0%),其中有表皮葡萄球菌5例(20.0%),头状葡萄球菌2例(8.0%),人葡萄球菌2例(8.0%),沃氏葡萄球菌1例(4.0%),溶血葡萄球菌2例(8.0%),未分类的凝固酶阴性葡萄球菌7例(28.0)。其他的致病菌包括:金黄色葡萄球菌1例(4.0%),藤黄微球菌1例(4.0%),麻疹孪生球菌1例(4.0%),肺炎克雷白菌1例(4.0%),库克菌属1例(4.0%),施氏假单胞菌1例(4.0%)。
种类 | 例数n | 比例% |
---|---|---|
共计囊袋培养阳性 | 25 | 100 |
凝固酶阴性葡萄球菌 | 19 | 76 |
表皮葡萄球菌 | 5 | 20 |
头状葡萄球菌 | 2 | 8 |
人葡萄球菌 | 2 | 8 |
沃氏葡萄球菌 | 1 | 4 |
溶血葡萄球菌 | 2 | 8 |
未分类 | 7 | 28 |
藤黄微球菌 | 1 | 4 |
麻疹孪生球菌 | 1 | 4 |
肺炎克雷白菌 | 1 | 4 |
金黄色葡萄球菌 | 1 | 4 |
库克菌属 | 1 | 4 |
施氏假单胞菌 | 1 | 4 |
表1. 囊袋微生物培养结果
单因素Logistic回归分析中,男性(P = 0.001),手术次数(P = 0.013),术前三个月内应用抗生素大于10天(P = 0.024),长期使用抗血小板药物(P = 0.010),在囊袋培养阳性及囊袋培养阴性两组差异有统计学意义(P < 0.05)。
多因素Logistic回归分析结果中,性别为男性(P = 0.001, OR = 14.001, 95%CI: 2.825~69.401),术前三月内抗生素使用大于10天(P = 0.002, OR = 27.935, 95%CI: 3.446~226.437),服用抗血小板药物(P = 0.008, OR = 3.761, 95%CI: 1.406~10.058)为无症状亚临床囊袋感染的独立危险因素。见表2,表3。
囊袋培养阴性 (n = 154) | 囊袋培养阳性 (n = 25) | 总体 | P值 | |
---|---|---|---|---|
年龄(岁) | 74.29 ± 12.16 | 72.96 ± 14.4 | 74.10 ± 12.46 | 0.623 |
性别 | ||||
男 | 79 | 22 | 101 | |
女 | 75 | 3 | 78 | 0.001 |
起搏器植入指征 | ||||
病窦综合症 | 100 | 17 | 117 | 0.089 |
传导阻滞 | 54 | 8 | 62 |
手术指征 | ||||
---|---|---|---|---|
电池耗竭 | 147 | 24 | 171 | 0.835 |
升级 | 5 | 1 | 6 | |
电极调整术 | 2 | 0 | 0 | |
房颤 | 62 | 5 | 67 | 0.052 |
窦性心律 | 92 | 20 | 112 | |
合并疾病 | ||||
糖尿病 | 36 | 7 | 43 | 0.616 |
肾功能不全 | 14 | 2 | 16 | 0.906 |
慢性心脏病 | 61 | 9 | 70 | 0.732 |
慢性阻塞性肺病 | 10 | 0 | 10 | 0.19 |
免疫抑制 | 1 | 0 | 1 | 0.686 |
恶性疾病 | 2 | 1 | 3 | 0.329 |
既往用药史 | ||||
近期抗生素应用(术前3个月内 > 10天) | 4 | 3 | 7 | 0.024 |
抗血小板药物 | 36 | 12 | 48 | 0.01 |
抗凝药 | 4 | 2 | 6 | 0.164 |
植入时间(月) | 113.25 ± 48.78 | 124.16 ± 35.51 | 114.78 ± 47.22 | 0.285 |
更换次数 | ||||
1次 | 128 | 17 | 145 | 0.013 |
2次 | 17 | 8 | 25 | |
3次 | 9 | 0 | 9 | |
临时起搏器使用 | 6 | 2 | 8 | 0.357 |
起搏器类型 | ||||
单腔起搏器 | 39 | 8 | 47 | 0.068 |
双腔起搏器 | 113 | 16 | 129 | |
ICD | 2 | 0 | 2 | |
CRT | 0 | 1 | 1 |
表2. 起搏器更换患者囊袋培养结果的单因素分析
P | OR | 95%CI | |
---|---|---|---|
性别 | 0.001 | 14.001 | 2.825~69.401 |
近期使用抗生素(术前3月内使用 > 10天) | 0.002 | 27.935 | 3.446~226.437 |
抗血小板药物 | 0.008 | 3.761 | 1.406~10.058 |
表3. 亚临床囊袋感染危险因素多因素Logistic回归分析
囊袋培养阳性组的25人中,有1人(4%)在出院后的第41个月因囊袋感染返院清创后剪断电极固定,该患者的囊袋培养结果为人葡萄球菌。有6名患者在随访的60个月内死亡,死亡原因为非CIED相关。7人失访(未再返院或报告CIED感染)。
囊袋培养阴性组无人报告CIED相关感染,60个月后随访期中有14人去世,死亡原因为非CIED相关。有84人失访(未再返院或报告CIED感染)。
从上述病人中随机抽取108例行5种炎性因子测定。参与炎性因子测定的患者的基本资料如表4。
囊袋培养阴性(n = 95) | 囊袋培养阳性(n = 13) | 总计 | |
---|---|---|---|
年龄(岁) | 74.83 ± 11.4 | 69.15 ± 18.76 | |
性别 | |||
男 | 43 | 12 | 55 |
女 | 52 | 1 | 53 |
起搏器植入指征 | |||
病窦综合症 | 59 | 8 | 67 |
传导阻滞 | 36 | 5 | 41 |
手术指征 | |||
电池耗竭 | 91 | 13 | 104 |
升级 | 4 | 0 | 4 |
房颤 | 38 | 2 | 40 |
无 | 57 | 11 | 68 |
合并疾病 | |||
糖尿病 | 21 | 3 | 24 |
肾功能不全 | 7 | 1 | 8 |
慢性心脏病 | 42 | 4 | 46 |
慢性阻塞性肺病 | 5 | 0 | 5 |
免疫抑制 | 0 | 0 | 0 |
恶性疾病 | 0 | 1 | 1 |
感染疾病史 | 4 | 0 | 4 |
无合并疾病 | 18 | 4 | 22 |
既往用药史 | |||
既往抗生素使用 | 3 | 1 | 4 |
抗血小板药物 | 23 | 6 | 29 |
抗凝药 | 3 | 1 | 4 |
植入时间(月) | 112.02 ± 49.58 | 111.00 ± 26.73 |
表4. 参与炎性因子测定的患者的基本资料与培养结果
108例患者中囊袋培养阴性95例,囊袋培养阳性13例。囊袋培养阳性组与囊袋培养阴性组5种炎性因子之间无显著差异。详见表5。
炎性因子 | 囊袋培养阴性(n = 95) | 囊袋培养阳性(n = 13) | P值 |
---|---|---|---|
CRP (mg/L) | 69.39 ± 9.16 | 67.27 ± 8.39 | 0.41 |
IL-1 (ng/L) | 17.60 ± 3.79 | 17.75 ± 2.33 | 0.836 |
IL-6 (ng/L) | 8.43 ± 1.75 | 8.42 ± 1.11 | 0.992 |
MCP (pg/ml) | 673.27 ± 95.61 | 666.66 ± 90.60 | 0.809 |
PCT (ng/ml) | 72.1585 ± 6.5842 | 73.7646 ± 9.0366 | 0.433 |
表5. CIED更换患者5种炎性因子与囊袋培养结果的相关性
排除合并基础疾病,包括心房颤动、糖尿病、肾功能不全、慢性心脏病、慢性阻塞性肺疾病病、免疫抑制状态(使用激素或免疫抑制药物)、恶性疾病(各种恶性肿瘤)、感染疾病后,筛选出无上述合并症受试者22例,与囊袋培养结果行相关性分析。结果显示,即使排除合并疾病的影响,囊袋培养阳性组与囊袋培养阴性组之间的炎症因子值没有统计学差异。见表6。
炎性因子 | 囊袋培养阴性(n = 18) | 囊袋培养阳性(n = 4) | P值 |
---|---|---|---|
CRP (mg/L) | 60.48 ± 9.16 | 67.93 ± 8.39 | 0.261 |
IL-1 (ng/L) | 18.79 ± 3.79 | 17.71 ± 2.33 | 0.320 |
IL-6 (ng/L) | 8.48 ± 1.75 | 8.24 ± 1.11 | 0.800 |
MCP (pg/ml) | 573.75 ± 64.52 | 646.52 ± 96.70 | 0.080 |
PCT (ng/ml) | 76.15 ± 7.25 | 73.7246 ± 7.72 | 0.501 |
表6. 无合并症患者5种炎性因子与囊袋培养结果的相关性分析
入组40例正常人(年龄50~60岁,男女各20例),测定5种炎性因子,起搏器更换患者与正常人之间对比,5种炎性因子均存在显著差异。详见表7。
炎性因子 | 起搏器更换患者(n = 108) | 正常人(n = 4) | P值 |
---|---|---|---|
CRP (mg/L) | 69.14 ± 9.06 | 46.25 ± 12.53 | 0.000 |
IL-1 (ng/L) | 17.60 ± 3.79 | 1.24 ± 0.40 | 0.000 |
IL-6 (ng/L) | 8.43 ± 1.68 | 6.78 ± 2.86 | 0.001 |
MCP (pg/ml) | 672.48 ± 94.64 | 544.45 ± 115.21 | 0.000 |
PCT (ng/ml) | 72.35 ± 6.89 | 3.77 ± 1.47 | 0.000 |
表7. CIED更换患者与对照组炎性因子对照
即使是排除合并疾病的受试者,其炎性因子与正常对照组之间也存在显著差异。见表8。
炎性因子 | 无合并症受试者(n = 22) | 正常人(n = 40) | P值 |
---|---|---|---|
CRP (mg/L) | 66.57 ± 9.06 | 46.25 ± 12.53 | 0.000 |
IL-1 (ng/L) | 17.90 ± 3.11 | 1.24 ± 0.40 | 0.000 |
IL-6 (ng/L) | 8.29 ± 1.64 | 6.78 ± 2.86 | 0.001 |
MCP (pg/ml) | 633.29 ± 93.64 | 544.45 ± 115.21 | 0.000 |
PCT (ng/ml) | 73.67 ± 7.54 | 3.77 ± 1.47 | 0.000 |
表8. 无合并症患者与对照组的炎性因子比较
国内外的研究当中,没有临床感染症状的CIED植入患者,囊袋培养阳性的概率约为15%~33% [
本研究认为性别为男性、长期应用抗血小板药物、术前3个月内使用抗生素 > 10天为无症状囊袋感染的独立危险因素。男性患者更容易发生CIED相关感染已有大样本临床研究证实 [
在本研究为期60个月的随访中,囊袋培养阳性的患者中有1名在术后41个月出现囊袋感染并返院清创剪断电极,占全部囊袋培养阳性的患者的4%,培养致病菌为人葡萄球菌(一种凝固酶阴性葡萄球菌),而培养阴性组未报告CIED相关感染。该结果与多项临床研究相近。Kleemann [
炎症因子如CRP (C-reactive protein,C反应蛋白) [
本研究显示,行CIED置换的病人,无论囊袋培养是否阳性,其炎症因子都有明显的增高,提示患者可能处于炎症反应激活的状态。但遗憾的是,囊袋培养阴性的患者与囊袋培养阳性的患者之间,二者的上述5项炎症因子都没有见到差别。为了排除临床基础疾病对炎症因子的影响,本研究将有合并症的患者剔除后进行了亚组分析,剔除合并症的患者与正常人相比,炎症因子仍然明显增高,但无合并症的患者囊袋培养阳性组与囊袋培养阴性组之间的炎症因子值没有统计学差异。推测原因可能为亚组分析的病例数较小,并且,无论是否合并基础疾病,手术都造成了炎症反应的激活,因而导致亚临床感染的因素在炎症因子的贡献中减小。在Zou [
临床中多数情况下炎症因子的升高与感染相关,但炎症因子并非拥有较好的特异性。CRP可在感染下升高,也可在手术、自身免疫病中增高,特异性不强 [
课题名称:首都特色临床应用研究成果与推广。课题编号:Z171100001017203。
该研究已经获得相应的伦理许可。
崔 文,刘俊鹏,高 旭,王志蕾,金 鑫,吴素娟,林高峰,佟佳宾,杨杰孚,邹 彤. 植入型心脏电子装置无症状囊袋感染的危险因素、预后与炎症因子预测价值的分析Analysis of Risk Factors and the Predictive Value of Inflammatory Factors of Cardiac Implantable Electronic Device Relevant Asymptomatic Pockets Infections[J]. 临床医学进展, 2021, 11(02): 810-820. https://doi.org/10.12677/ACM.2021.112115