标题：MRSA重症肺炎患儿TLR2、TLR4、PCT、CRP、APACHEⅡ评分变化及临床意义

      作者：路海荣 1，宇文小蕾 1，易建华 2    1.咸阳彩虹医院医学检验科，陕西 咸阳 712000；2.西安医学高等专科学校附属医院医学检验科，陕西 西安 710309

      卷次： 2023年34卷18期

      【摘要】 目的 探讨耐甲氧西林金黄色葡萄球菌(MRSA)感染的重症肺炎(SP)患儿 Toll样受体 2 (TLR2)、Toll样受体 4 (TLR4)、降钙素原(PCT)和C-反应蛋白(CRP)、急性生理与慢性健康(APACHEⅡ)评分变化及临床意义。方法 回顾性分析2021年10月至2022年9月咸阳彩虹医院收治的120例SP患儿的临床资料，根据患儿是否感染MRSA分为感染组(n=54)和未感染组(n=66)，另选取同期体检健康儿童60例作为对照组。分析MRSA感染SP患儿菌株耐药性情况；检测并比较三组受试者TLR2、TLR4、PCT、CRP水平；对感染组患儿随访60 d，记录患儿生存情况；采用多因素Logistic回归分析影响MRSA感染患儿预后的相关因素；收集SP患儿入院后的APACHEⅡ评分状况，绘制受试者工作特征曲线(ROC)，计算曲线下面积(AUC)，评估TLR2、TLR4、PCT、CRP、APACHE Ⅱ评分对SP患儿预后的诊断价值。结果 细菌耐药情况分析发现，对青霉素、红霉素、克林霉素、苯唑西林、氨苄西林、四环素的耐药性较强(>80%)，对呋喃妥因、替加环素、万古霉素、利奈唑胺耐药性较弱(<30%)；感染组患儿的血清TLR2、TLR4、CRP、PCT表达水平及APACHE Ⅱ 评分分别为(2.76±1.37) ng/mL、(2.68±1.33) ng/mL、(94.83±22.67) mg/L、(3.38±1.63) ng/mL、(29.82±7.53)分，明显高于未感染组的(1.25±0.87) ng/mL、(1.32±1.06) ng/mL、(72.33±21.54) mg/L、(1.26±0.27) ng/mL、(18.85±6.67)分，未感染组患儿的 TLR2、TLR4、CRP、PCT表达水平明显高于对照组的(0.45±0.18) ng/mL、(0.45±0.15) ng/mL、(5.28±2.27) mg/L、(0.37±0.15) ng/mL，差异均有统计学意义(P<0.05)。60 d随访，感染组患儿死亡22例(死亡组)，生存32例(生存组)；死亡组患儿的血清TLR2、TLR4、CRP、PCT水平及APACHE Ⅱ 评分分别为 2.31±0.72、2.29±0.58、(96.68±23.69) mg/L、(3.45±1.89) ng/mL、(32.56±5.57)分，明显高于生存组的 1.26±0.37、1.35±0.29、(74.46±20.55) mg/L、(1.35±7.086) ng/mL、(23.95±5.68)分，差异均有统计学意义(P<0.05)；经多因素Logistic回归分析结果显示，高PCT、高CRP、高TLR2、高TLR4、高PACHEⅡ评分是MRSA感染SP患儿预后不良的危险因素(P<0.05)；经ROC分析结果显示，APACHEⅡ评分的AUC为0.887，PCT、CRP的AUC分别为0.830、0.812；血清各指标预测MRSA感染SP患儿的特异性最高为PCT (88.4%)，敏感性为72.2%，其次是APACHEⅡ评分特异性为86.5%，敏感性为88.3%。结论 TLR2、TLR4、PCT、CRP、APACHEⅡ评分有利于儿童SP感染MRSA的鉴别诊断，有助于指导临床中抗菌药物的合理使用、病情有效评估和预后疗效判断，联合检测结果可以有效提高诊断准确度。
      【关键词】 重症肺炎；耐甲氧西林金黄色葡萄球菌；炎症；降钙素原；细菌感染；C-反应蛋白
      【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350（2023）18—2701—05

Changes in TLR2, TLR4, PCT, CRP, APACHE Ⅱ scores and their clinical significance in patients with MRSAinfection with SP.
LU Hai-rong 1, YUWEN Xiao-lei 1, YI Jian-hua 2. 1. Department of Medical Laboratory, XianyangRainbow Hospital, Xianyang 712000, Shaanxi, CHINA; 2. Department of Medical Laboratory, Affiliated Hospital of Xi'anMedical College, Xi'an 710309, Shaanxi, CHINA
【Abstract】 Objective To investigate the changes and clinical significance of toll-like receptor 2 (TLR2),toll-like receptor 4 (TLR4), procalcitonin (PCT), and C-reactive protein (CRP), acute physiology and chronic health(APACHE Ⅱ) scores in children with severe pneumonia (SP) infected by methicillin-resistant Staphylococcus aureus(MRSA). Methods The clinical data of 120 children with SP admitted to Xianyang Rainbow Hospital from October2021 to September 2022 were retrospectively analyzed. According to whether the children were infected with MRSA,they were divided into two groups, including the infected group (n=54) and the uninfected group (n=66). Another 60healthy children in the same period were selected as the control group. The drug resistance of SP in children infectedwith MRSA was analyzed. The levels of TLR2, TLR4, PCT, and CRP in the three groups were detected and compared.The children in the infected group were followed up for 60 days, the survival of the children was recorded, and the relat-ed factors affecting the prognosis of the children with MRSA infection were analyzed by multivariate Logistic regres-sion. The APACHEⅡ scores of children with SP were collected after admission. The receiver operating characteristiccurve (ROC) was plotted, the area under the curve (AUC) was calculated, and the diagnostic value of TLR2, TLR4, PCT,CRP and APACHEⅡ scores on the prognosis of children with SP was evaluated. Results Analysis of bacterial resis-tance showed strong resistance to penicillin, erythromycin, clindamycin, oxacillin, ampicillin, and tetracycline (>80%)and weak resistance to nitrofurantoin, tigecycline, vancomycin, and linezolid (<30%). The serum expression levels ofTLR2, TLR4, CRP, PCT, and APACHE Ⅱ scores in the infected group were (2.76±1.37) ng/mL, (2.68±1.33) ng/mL,(94.83±22.67) mg/L, (3.38±1.63) ng/mL, (29.82±7.53) points, which were significantly higher than (1.25±0.87) ng/mL,(1.32±1.06) ng/mL, (72.33±21.54) mg/L, (1.26±0.27) ng/mL, (18.85±6.67) points in non-infected group; the expressionlevels of TLR2, TLR4, CRP, and PCT in the non-infected group were significantly higher than (0.45±0.18) ng/mL,(0.45±0.15) ng/mL, (5.28±2.27) mg/L, (0.37±0.15) ng/mL in the control group; the differences were statistically signif-icant (P<0.05). TLR2, TLR4, CRP, PCT, APACHE Ⅱ score and the combination of multiple indicators showed a sig-nificant positive correlation with the prognosis of children with MRSA infected SP, and the difference was statisticallysignificant (P<0.05). Multivariate Logistic regression analysis showed that high PCT, high CRP, high TLR2, highTLR4, and high PACHEⅡscores were risk factors for poor prognosis in children with MRSA infection SP (P<0.05).ROC analysis showed that the area under the curve (AUC) of APACHE Ⅱ score was 0.887, that of PCT and CRP was0.830 and 0.812; the specificity of MRSA-infected SP children was highest in PCT (88.4% ), with a sensitivity of72.2%, followed by APACHE Ⅱ score (86.5%), with a sensitivity of 88.3%. Conclusion TLR2, TLR4, PCT, CRP,and APACHE Ⅱ scores are conducive to the differential diagnosis of MRSA in children with SP pneumonia infection,and is helpful to guide the rational use of antibacterial drugs in clinical practice, effective assessment of disease andprognosis and efficacy judgment. The detection results of combined indicators can effectively improve the diagnosticaccuracy.
      【Key words】 Severe pneumonia; Methicillin-resistant Staphylococcus aureus; Inflammation; Procalcitonin; Bacte-rial infections; C-reactive protein