Objective:To investigate the changes and clinical significance of lymphocyte ratio (NLR), procalcitonin (PCT), carbohydrate antigen 125 (CA125), and D-dimer (D-D) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accompanied by respiratory failure.Methods:A total of 160 patients with AECOPD who were admitted to Liaocheng Second People's Hospital from August 2019 to June 2022 were retrospectively selected. According to whether they were combined with respiratory failure, they were divided into an observation group (AECOPD combined with respiratory failure) of 60 cases and a control group (AECOPD non-respiratory failure) of 100 cases. In the observation group, there were 40 males and 20 females; they were 56-85 (67.54±5.67) years old; the course of COPD was 2-16 (5.03±1.49) years. In the control group, there were 65 males and 35 females; they were 57-84 (66.94±5.61) years old; the course of COPD was 2-17 (5.12±1.57) years. The acid-base (pH) values, partial pressures of oxygen (PaO 2) partial pressures of arterial blood carbon dioxide (PaCO 2), percentages of forced expiratory volume in the first second (FEV1%) of the expected value, and serum levels of NLR, PCT, D-D, and CA125 in the two groups were detected and analyzed. t test was applied. Results:The PaCO 2 was higher and the PaO 2, FEV1%, and pH were lower in the observation group than in the control group ( t=30.19, 24.53, 18.72, and 27.24; all P<0.05). The serum levels of NLR, PCT, D-D, and CA125 in the observation group were higher than those in the control group ( t=39.40, 142.09, 25.56, and 12.45; all P<0.05). The serum levels of NLR, PCT, D-D, and CA125 were negatively correlated with PaO 2 and pH ( r=-0.733, -0.666, -0.695, -0.549, -0.762, -0.742, -0.673, and -0.598; all P<0.05), and positively with PaCO 2 ( r=0.651, 0.679, 0.784, and 0.684; all P<0.05). Conclusion:The higher the serum levels of NLR, PCT, D-D, and CA125 in patients, the higher the PaCO 2, the lower the PaO 2 and pH, and the more serious the disease. The detection of the above serum factors can be used in clinic to assist clinicians in making auxiliary judgment on the severity of AECOPD patients with respiratory failure, so as to give the patients targeted treatment as early as possible and improve their prognosis.

目的:研究该院2016～2020年血培养病原菌的分布特点及耐药性,为临床治疗及合理选择抗菌药物提供依据.方法:分析该院2016～2020年期间临床血培养分离的999株病原菌的药敏结果,按照CLSI2019年标准,使用WHONET5.6软件进行数据分析.结果:革兰阴性菌分离率最高,共670株(67.1％),其次是革兰阳性菌,共317株(31.7％),真菌共12株(1.2％).血培养分离前五位的细菌分别是大肠埃希菌449株(44.9％),肺炎克雷伯菌97株(9.7％),人葡萄球菌69株(6.9％),金黄色葡萄球菌53株(5.3％),表皮葡萄球菌52株(5.2％).革兰阴性杆菌中大肠埃希菌和肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢替坦、厄他培南、亚胺培南、美罗培南、阿米卡星的耐药率低均低于5％.耐碳青霉烯类肠杆菌科细菌(CRE)共检出8株(0.8％),其中耐碳青霉烯类的大肠埃希菌(CR-eco)6株,耐碳青霉烯类的肺炎克雷伯菌(CR-kpn)2株,CRE对大多数临床常用抗菌药物呈高度耐药,对阿米卡星、替加环素有较高敏感性.鲍曼不动杆菌对大多数抗菌药物的耐药率均较高,对碳青霉烯类药物耐药率为66.7％,铜绿假单胞菌对多数抗菌药物敏感.耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为45.3％,未发现对万古霉素耐药的葡萄球菌和肺炎链球菌.结论:该院血培养以革兰阴性菌为主,不同病原菌对抗生素的耐药性有一定差异.应充分利用药敏结果进行感染控制,合理选择抗菌药物,减少耐药菌的出现.

目的 研究聊城地区新德里金属β-内酰胺酶(NDM)菌株的分子流行病学及感染危险因素.方法 采用分层抽样法从聊城地区2014年1月至2018年12月15所医院中抽取样本5689例,其中,临床标本中分离的碳青霉烯类耐药肠杆菌科细菌共112份,回顾性研究分析院内感染危险因素.用改良Hodge试验、ETP-EDTA协同试验、mCIM试验确证表型.用PCR法扩增碳青霉烯酶基因.结果 5689例样本中临床标本中分离的碳青霉烯类耐药肠杆菌科细菌共112份,发生率1.97％.可见,不同危重度、合并基础疾病、存在侵入性操作、使用糖皮质激素、使用免疫抑制剂药物是碳青霉烯类耐药情况下碳青霉烯类耐药肠杆菌科细菌感染率差异有统计学意义(P<0.05).Logistic回归分析模型结果 显示,危重度(符合并入住ICU)、合并基础疾病(2种及以上)、存在侵入性操作、使用糖皮质激素、使用免疫抑制剂药物是碳青霉烯类耐药肠杆菌科细菌感染的独立危险因素(OR=1.977、1.558、1.103、1.078、1.770,P<0.05),26株产NDM肠杆菌科细菌呈现多重耐药性,其中7株对亚胺培南耐药、8株对厄他培南耐药、6株对美罗培南耐药,5株对3种药物都敏感.PCR结果 显示,26株产NDM的大肠埃希菌分为4个基因型,其中9株D型,8株B型,5株C型,4株A型.结论 医院已出现多种NDM亚型,主要感染因素为侵袭性操作及抗生素的应用,主要通过X3型质粒在肠杆菌科细菌中传播.

目的:分析入住重症监护室(ICU)期间发生肠杆菌科细菌所致血流感染患者病原菌的分布情况及耐药性.方法:选取2015年1月至2019年12月期间在山东第一医科大学附属聊城二院ICU住院期间发生肠杆菌科细菌所致血流感染的106例患者作为研究对象.采集这些患者的血液标本进行病原菌培养,观察其病原菌的分布情况.对获得的主要菌株进行药敏试验,分析此类病原菌的耐药性.结果:在这些患者的血液样本中,共分离出115株肠杆菌科细菌.在检出的这些菌株中,大肠埃希菌占71.30％,肺炎克雷伯菌占21.74％.大肠埃希菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢替坦、厄他培南、亚胺培南、美罗培南、阿米卡星的敏感率均>80％,对氨苄西林/舒巴坦、头孢唑啉、头孢曲松、环丙沙星、左旋氧氟沙星、复方新诺明的耐药率均>50％.肺炎克雷伯菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢吡肟、头孢替坦、厄他培南、亚胺培南、美罗培南、阿米卡星、庆大霉素的敏感率均>80％,对氨苄西林/舒巴坦、头孢唑啉、头孢曲松、环丙沙星的耐药率均>30％.结论:这些患者感染的肠杆菌科细菌主要是大肠埃希菌和肺炎克雷伯菌.大肠埃希菌对环丙沙星、左旋氧氟沙星等抗生素的耐药性较高,对头孢替坦、厄他培南等抗生素的敏感性较高.肺炎克雷伯菌对氨苄西林/舒巴坦、头孢唑啉等抗生素的耐药性较高,对厄他培南、亚胺培南等抗生素的敏感性较高.

目的:探讨并分析产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的耐药性及影响产ESBLs大肠埃希菌所致血流感染患者预后的因素.方法:选择聊城市第二人民医院收治的253例大肠埃希菌所致血流感染患者作为研究对象.对这些患者均进行血培养,观察其血液中大肠埃希菌的检出情况,总结产ESBLs大肠埃希菌的耐药性,观察其中产ESBLs大肠埃希菌所致血流感染患者的预后,并分析影响其预后的因素.结果:对这253例患者进行血培养共培养出253株大肠埃希菌,其中产ESBLs的大肠埃希菌有120株(占47.43％).产ESBLs的大肠埃希菌对氨苄西林、氨苄西林钠舒巴坦钠、头孢唑啉、头孢呋辛、头孢他啶、头孢曲松、氨曲南、环丙沙星、左旋氧氟沙星和复方新诺明均有较高的耐药性,其对头孢哌酮钠舒巴坦钠、哌拉西林钠他唑巴坦钠、头孢替坦、厄他培南、亚胺培南和美洛培南的耐药性较低.通过进行多因素logistic回归分析可知,进行有创机械通气和深静脉置管是影响产ESBLs大肠埃希菌所致血流感染患者预后的危险因素.结论:产ESBLs的大肠埃希菌对氨苄西林、氨苄西林钠舒巴坦钠、头孢唑啉等抗生素均有较高的耐药性,影响产ESBLs大肠埃希菌所致血流感染患者预后的危险因素主要是其进行有创机械通气和深静脉置管.

Amino terminal pro-brain natriuretic peptide (NT-proBNP) is an important biomarker for clinical diagnosis, risk stratification, prognosis evaluation, and efficacy monitoring in patients with acute and chronic heart failure. Traditionally, NT-proBNP detection is based on immunochromatography, which is time-consuming, tedious, requires professional-trained operators, etc. Here we developed a simple, fast, unlabeled, highly sensitive, and low-cost carbon nanotubes (CNTs)@Au NPs-modified electrochemiluminescence NT-proBNP sensor, and evaluated its feasibility in the clinical monitoring of cardiac function in patients with heart failure. Notably, the sensor has a small batch size difference and good reproducibility and can be used for mass production. The device offers a new opportunity and direction for the clinical monitoring of NT-proBNP.

目的 对该院2013-2017年住院患者分离的肠杆菌科细菌分布及药敏情况进行统计分析,为临床治疗及合理选择抗菌药物提供依据.方法 采用纸片扩散法(K-B法)或自动化仪器(VITEK2-compact系统)对临床分离的5562株非重复肠杆菌科细菌进行药敏试验,并按美国临床实验室标准化协会(CLSI)相关标准判断药敏结果.结果 共收集该院临床分离的非重复肠杆菌科细菌5562株,其中大肠埃希菌2820株,肺炎克雷伯菌1607株,阴沟肠杆菌317株及其他肠杆菌科细菌818株.5年间肠杆菌科细菌的检出率基本持平,2013年为50.9％,2017年为51.1％.药敏试验数据显示,所有肠杆菌科细菌对哌拉西林/他唑巴坦、亚胺培南、厄他培南、头孢替坦和阿米卡星保持了高的敏感率(>90.0％),对头孢哌酮/舒巴坦、头孢他啶和头孢吡肟也有较高的敏感率(73.0％～89.3％),对氨曲南、庆大霉素、妥布霉素、左氧氟沙星、环丙沙星、氨苄西林/舒巴坦、头孢唑林、头孢曲松、复方磺胺甲噁唑的敏感率较低(27.3％～66.1％),对氨苄西林的敏感率最低(8.0％).5年间,产超广谱β-内酰胺酶(ESBLs)大肠埃希菌检出率从62.7％上升到64.6％;产ESBLs肺炎克雷伯菌检出率从37.5％下降至30.5％.碳青霉烯类耐药肠杆菌科细菌(CRE)检出率为1.6％.结论 肠杆菌科细菌对常见抗菌药物的耐药率总体呈下降趋势,但CRE菌株的日趋增多,给临床治疗造成严重影响,应充分利用细菌耐药监测结果进行感染控制,提高临床抗菌药物合理使用的意识,有效遏制该类菌株感染的发生.

目的 评价抗感染治疗前后痰细菌培养动态结果变化分析对于ICU重症感染老年患者的效果.方法 选择该院2018年1月-2019年4月期间收治的ICU重症感染患者76例,所有患者均采用重症下呼吸道或肺部感染患者痰培养结果分析,观察患者抗感染治疗前后痰细菌培养结果动态变化.结果 76例ICU重症感染老年患者痰菌培养阳性率为55.26％,患者患者后第1周、第2周、第3周的痰菌培养阳性率为73.68％、85.53％,97.37％,治疗第4周的痰菌培养阳性率为100.00％.早期痰培养主要以假丝酵母菌属、铜绿假单细胞菌、革兰阳性球菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌.后期中常见为铜绿假单细胞菌、嗜麦芽寡养单胞菌和鲍氏不动杆菌等非发酵菌.在抗感染治疗后,假丝酵母菌属、革兰阳性球菌清除率较高.结论 随着重症监护病房住院时间的延长,下呼吸道细菌感染率明显增加,非发酵菌为主要致病菌,为了预防各种因素引起的急性肾功能衰竭,应进一步了解痰培养观察在重症监护病房的重要性.

目的 探讨血清前列腺特异性抗原(PSA)联合超声引导下前列腺细针穿刺细胞学检查对前列腺癌的诊断价值.方法 选择在该院住院并行血清PSA检查、超声引导下前列腺细针穿刺细胞学检查、前列腺全切除病理确诊的患者80例为研究对象,收集患者临床资料,分析上述不同方式对前列腺癌的诊断率及诊断效能.结果 80例患者中,前列腺癌患者25例(31.25％),非前列腺癌患者55例(68.75％).非前列腺癌患者包括良性前列腺增生43例(53.75％),前列腺炎12例(15.00％).血清PSA检查、超声引导下前列腺细针穿刺细胞学检查、血清PSA联合超声引导下前列腺细针穿刺细胞学检查均能有效检测前列腺癌,差异有统计学意义(P<0.05).血清PSA联合超声引导下前列腺细针穿刺细胞学检查对前列腺癌的诊断价值高于单独方式的诊断价值.结论 血清PSA联合超声引导下前列腺细针穿刺细胞学检查可极大提高前列腺癌的诊断率.

目的:分析尿内毒素检测联合尿常规检测在泌尿系统感染早期诊断中的应用价值.方法:将2019年1月至2019年6月期间聊城市第二人民医院收治的300例疑似泌尿系统感染的患者作为研究对象.收集这些患者的清洁中段尿液标本,对其清洁中段尿液标本进行尿细菌培养检测,以该检测的结果作为本次研究的金标准.对这300例患者均进行尿内毒素检测及尿常规检测.然后,对比这300例患者进行尿内毒素单项检测、尿常规单项检测及尿内毒素检测联合尿常规检测在诊断其病情方面的准确率和特异性.结果:与进行尿内毒素单项检测及尿常规单项检测相比,进行尿内毒素检测联合尿常规检测在诊断患者病情方面的准确率及特异性均更高,P<0.05.结论:尿内毒素检测联合尿常规检测在泌尿系统感染早期诊断中的应用价值显著.

Objective: To study the changes in serum C-reactive protein and plasma amyloid protein levels in suspected Alzheimer's disease (AD) patients. Patients and methods: Sixty patients that likely had AD according to preliminary diagnosis were selected as the observation group, while 60 healthy patients who did not have AD were selected as the control group. General patient characteristics, serum C-reactive protein (CRP), plasma amyloid beta A beta 1-40 and A beta 1-42 levels were observed in both groups. The 60 patients in the observation group were divided into a progressive group (n=13) and a non progressive group (n=47) according to disease progression. General patient characteristics, CRP, plasma A beta 1-40 and A beta 1-42 levels were compared between the two groups, and risk factors of disease progression were analyzed. Results: There were significant differences in serum CRP and A beta 1-42/A beta 1-40 between the two groups (all P<0.001). In terms of education level, mini-mental state examination (MMSE) score, A beta 1-42, A beta 1-40, and A beta 1-42/A beta 1-40, the non progressive group had higher levels than the progressive group, while the non progressive group had significantly lower CRP than the progressive group (P<0.05). Logistic regression analysis of the involved factors showed that two indicators, A beta 1-42/A beta 1-40 and CRP, could be considered risk factors for disease progression. Conclusion: Serum CRP levels were high and A beta 1-42/A beta 1-40 ratio was low in suspected AD patients and both could be used as risk factors for disease progression in suspected AD patients.

目的 监测医院革兰阳性球菌的变化趋势及对抗菌药物敏感性的变化,以指导临床抗菌药物治疗的优化.方法 收集2013年1月—2015年12月聊城市第二人民医院1764例非重复革兰阳性球菌,应用肉汤稀释法测定最小抑菌浓度(MIC),比较主要革兰阳性球菌不同年份之间的感染发生率和药物敏感率.结果 2013年1月—2015年12月金黄色葡萄球菌、凝固酶阴性葡萄球菌感染率有下降趋势,而肺炎链球菌感染率呈明显上升趋势.结论 持续监测医院革兰阳性球菌的变化趋势及对抗菌药物敏感性的变化,有助于对感染患者合理应用抗菌药物.