恶性肿瘤患者血流感染病原分析及血糖检测的临床意义

陈祝俊; 丁志敏; 马晓路; 王砚春; 胡昊昀; 卢仁泉; 郭林

doi:10.19401/j.cnki.1007-3639.2023.10.005

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恶性肿瘤患者血流感染病原分析及血糖检测的临床意义

论著 | 更新时间：2025-12-31

- 恶性肿瘤患者血流感染病原分析及血糖检测的临床意义
- Analysis of characteristics of infectious pathogens in malignant tumors combined with bloodstream infection and significance of serum glucose detection
- 中国癌症杂志 2023年33卷第10期页码：927-935
- 作者机构：
  
  1. 复旦大学附属肿瘤医院检验科，复旦大学上海医学院肿瘤学系，上海 200032
  2. 上海中医药大学附属曙光医院检验科，上海 201203
- 作者简介：
  
  [ "陈祝俊（ORCID：0009-0003-3159-8068），主管技师。" ]
  郭林（ORCID：0000-0002-8419-3350），主任技师，复旦大学附属肿瘤医院检验科主任。
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.10.005
  中图分类号： R730.43
- 收稿：2023-07-03，
  
  修回：2023-09-06，
  
  纸质出版：2023-10-30
- 稿件说明：
移动端阅览
陈祝俊, 丁志敏, 马晓路, 等. 恶性肿瘤患者血流感染病原分析及血糖检测的临床意义[J]. 中国癌症杂志, 2023,33(10):927-935.

Zhujun CHEN, Zhimin DING, Xiaolu MA, et al. Analysis of characteristics of infectious pathogens in malignant tumors combined with bloodstream infection and significance of serum glucose detection[J]. China Oncology, 2023, 33(10): 927-935.
陈祝俊, 丁志敏, 马晓路, 等. 恶性肿瘤患者血流感染病原分析及血糖检测的临床意义[J]. 中国癌症杂志, 2023,33(10):927-935. DOI： 10.19401/j.cnki.1007-3639.2023.10.005.

Zhujun CHEN, Zhimin DING, Xiaolu MA, et al. Analysis of characteristics of infectious pathogens in malignant tumors combined with bloodstream infection and significance of serum glucose detection[J]. China Oncology, 2023, 33(10): 927-935. DOI： 10.19401/j.cnki.1007-3639.2023.10.005.

摘要

背景与目的：

恶性肿瘤患者合并血流感染（bloodstream infection，BSI）的发病率逐渐增高，其治疗结果与感染病原密切相关，同时血糖对该类患者病情发生、发展亦有重要影响。本研究旨在分析恶性肿瘤患者合并BSI时的病原菌分布特征，并探讨合并BSI时血糖检测的临床意义、变化趋势及其对患者的预后价值。

方法：

回顾性分析2019年10月—2022年12月在复旦大学附属肿瘤医院诊治的434例患恶性肿瘤合并BSI及同时期409例患恶性肿瘤未并发BSI患者的临床特征，统计患者合并BSI病原菌情况、空腹血糖、降钙素原（procalcitonin，PCT）等指标，并收集患者的随访信息。采用SPSS 26.0、Graphpad等软件进行数据分析。

结果：

恶性肿瘤合并BSI最常见病原菌前3位是大肠埃希菌（29.4%）、肺炎克雷伯菌（13.8%）、铜绿假单胞菌（4.8%）。8.5%的患者存在两种及以上病原菌混合感染。最终与致死有关菌株100株，大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌仍列前3位，分别占21.0%、12.0%和10.0%。生存分析显示两种及以上病原菌混合感染与单一感染相比预后较差（

= 0.000）。恶性肿瘤合并BSI患者症状初期空腹血糖水平（中位数为7.39 mmol/ L，四分位区间为5.95 ~ 9.88 mmol/L）显著高于未发生BSI患者（中位数为5.97 mmol/L，四分位区间为5.25 ~ 7.06 mmol/L，

= 0.000）。疾病初期空腹血糖水平判定患者发生BSI的受试者工作特征（receiver operating characteristic，ROC）曲线的曲线下面积（area under the curve，AUC）为0.718，高于经典诊断标志物PCT（AUC = 0.708）；两者联合可进一步提高诊断效能（AUC = 0.761）。生存分析结果显示，BSI初期空腹血糖水平较高的患者预后较差（HR = 3.067，95% CI：1.375 ~ 6.838，

= 0.000）。此外，BSI初期空腹血糖变化程度越大，患者死亡风险越高（HR = 2.150，95% CI：1.125 ~ 4.109，

0.01）。

结论：

临床怀疑BSI患者应结合病原菌分布使用抗生素，并监测血糖水平以早期了解感染情况，采取干预措施，使患者获益。

Abstract

Background and purpose:

The incidence rate of bloodstream infection (BSI) in patients with malignant tumor increases gradually with the progress of anti-tumor treatment. The treatment ou

tcome is closely related to the infection of pathogen. At the same time

blood glucose also has a significant impact on the occurrence and development of the disease in this type of patients. This research aimed to retrospectively analyze the distribution characteristics of infectious pathogens isolated in patients with malignant tumors combined with bloodstream infection

the significance of serum glucose detection and prognostic value of its variation trend.

Methods:

Data of 434 malignant tumor patients with BSI and 409 patients without BSI treated in Fudan University Shanghai Cancer Center were retrospectively analyzed in this research. We utilized SPSS 26.0

Graphpad

Medcalc and Office software etc. to statistically analyze all the data covering clinical characteristics

infectious pathogens and biochemical parameters which were collected from Oct. 2019 to Dec. 2022.

Results:

The top three isolates in malignant tumor patients with BSI were

Escherichia coli

(29.4%)

Klebsiella pneumoniae

(13.8%) and

Pseudomonas aeruginosa

(4.8%). There were two or more mixed pathogenic bacteria in 8.5% patients. There were totally 100 deadly strains

among which the top three isolates were Escherichia coli

Klebsiella pneumoniae and Pseudomonas aeruginosa

accounting for 21.0%

12.0% and 10.0% of the diseases

respectively. Survival analysis showed that mixed infection had a poorer prognosis compared to single infection (

=0.000). The fasting blood glucose level at the initial stage of symptoms was significantly higher in malignant tumor patients with BSI (median 7.39 mmol/L

interquartile range 5.95-9.88 mmol/L) than in tumor patients without BSI (median 5.97 mmol/L

interquartile range 5.25-7.06 mmol/L

=0.000). The area under curve (AUC) of the receiver operating characteristic (ROC) curve of the patients with BSI determined by the fasting glucose level at the beginning of the disease was 0.718

which was higher

compared with procalcitonin (PCT)

the classic diagnostic marker (AUC=0.708). The combination of these two parameters could even improve diagnostic efficiency (AUC=0.761). Furthermore

survival analysis showed that the prognosis of patients with high level of fasting glucose at the beginning of BSI was poor (HR=3.067

95% CI: 1.375-6.838

=0.000). In addition

the greater the glycemic variability at the beginning of BSI

the higher the risk of death was shown (HR=2.150

95% CI: 1.125-4.109

0.01).

Conclusion:

It is suggested that patients with clinically suspected BSI should use antibiotics based on the distribution of isolates

and glucose levels should be monitored to access the infection early so as to take timely intervention and obtain greater treatment benefits.

关键词

Keywords

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