糖尿病足感染患者病原菌分布 和C-肽及视黄醇结合蛋白-4水平分析

摘要：目的 探讨糖尿病足感染患者病原菌分布、C-肽和视黄醇结合蛋白-4（RBP4）的水平以及感染相关危险因素。方法 收集乌鲁木齐市友谊医院和新疆生产建设兵团医院2016年2月至2017年6月住院的201例糖尿病足患者临床资料，依据是否发生感染分为感染组（n=63）和未感染组（n=138）。采用ELISA法检测两组患者血清中hs-CRP、PCT、D-二聚体、纤维蛋白原（FIB）、C-肽和RBP4水平并分析感染组患者病原菌分布情况。感染相关危险因素采用Logistic回归分析。结果 感染组患者血清hs-CRP、PCT、D-二聚体、FIB、RBP4、餐后2 h C-肽水平均显著高于未感染组（均P<0.05）。63例糖尿病足感染患者足部分泌物共分离培养出83株病原菌，其中革兰阴性菌46株（55.42%），以铜绿假单胞菌（24.10%）、大肠埃希菌（13.25%）居多；革兰阳性菌37株（44.58%），以金黄色葡萄球菌（37.34%）为主。单因素分析显示，两组患者在病程、使用抗菌药物、使用三代头孢、患糖尿病肾病、合并骨髓炎和神经缺损性伤口方面差异有统计学意义（均P<0.05）。多因素分析显示，患者病程、既往使用抗菌药物、使用三代头孢、合并骨髓炎和神经缺损性伤口均是感染发生的独立危险因素。结论 需依据病原菌分布及耐药性情况合理应用抗生素，并针对病程长、既往使用抗菌药物、使用三代头孢、合并骨髓炎和神经缺损性伤口等独立危险因素做好相应预防措施。

The pathogenic distribution and levels of C-peptide and RBP4 in patients with diabetic foot infection

Abstract: Objective To investigate the pathogenic distribution and levels of C-peptide and retinol binding protein-4 (RBP4) in patients with diabetic foot infection, and analyze the related factors. Methods The clinical data of 201 patients admitted to our hospital from February 2016 to June 2017 were collected. The patients were divided into the Infection group (n=63) or Non-infection group (n=138) according to whether they had the infection or not. The levels of hs-CRP, PCT, D-dimer, FIB, C-peptide and RBP4 were detected with ELISA, and the distribution of pathogens was analyzed. The risk factors of infection were analyzed using logistic regression analysis. Results The levels of serum hs-CRP, PCT, D-dimer, FIB, RBP4 and 2 h CP in the infection group were significantly higher than those in the non-infection group (all P<0.05). A total of 83 pathogens were isolated from the 63 patients with diabetic foot infection, among which 46 strains (55.42%) were Gram-negative bacteria, including Pseudomonas aeruginosa (24.10%) and Escherichia coli (13.25%); 37 strains (44.58%) were Gram-positive bacteria, including mainly Staphylococcus aureus (37.34%). Univariate analysis showed that there were significant differences in the course of disease, use of antibacterial drugs, use of third-generation Cephalosporins, diabetic nephropathy, osteomyelitis and neurological deficits (all P<0.05). Multivariate analysis showed that the course of disease, previous use of antibiotics, use of third-generation cephalosporins, concurrent osteomyelitis and neurological deficit wounds were the independent risk factors for the infection. Conclusion It is necessary to use antibiotics rationally according to the distribution of pathogens and drug resistance, and to take appropriate preventive measures against the independent risk factors such as long-term and previous use of antibiotics, use of third-generation Cephalosporins, osteomyelitis and nerve-deficient wounds.