乳腺癌患者术后PICC导管...原对感染发生风险的预测价值_周媛.pdf

现代生物医学进展Progress in Modern Biomedicine Vol.23NO.2JAN.2023doi:10.13241/ki.pmb.2023.02.016乳腺癌患者术后 PICC 导管相关性感染的危险因素及血清 C 反应蛋白、降钙素原对感染发生风险的预测价值*周媛1骆煜1胡琳琳1鲁娜2江莹3（1 武汉大学人民医院乳腺甲状腺外科 湖北 武汉 430060；2 武汉市第四医院肝胆甲乳外科 湖北 武汉 430030；3 武汉大学人民医院肿瘤科 湖北 武汉 430060）摘要 目的：分析乳腺癌患者术后经外周静脉置入中心静脉导管（PICC）相关性感染的危险因素并探讨血清 C 反应蛋白（CRP）、降钙素原（PCT）对感染发生风险的预测价值。方法：选取 2019 年 1 月2022 年 1 月我院收治的 150 例乳腺癌改良根治术后接受PICC 置管的乳腺癌患者，根据是否发生 PICC 导管相关性感染分为感染组 34 例和非感染组 116 例，收集患者临床资料，采用化学发光法检测置管前血清 CRP、PCT 水平。通过单因素和多因素 Logistic 回归分析乳腺癌患者术后 PICC 导管相关性感染的危险因素，绘制受试者工作特征（ROC）曲线分析血清 CRP、PCT 水平单独与联合检测对乳腺癌患者术后 PICC 导管相关性感染的预测价值。结果：单因素分析显示，与非感染组比较，感染组高血压病、糖尿病、TNM 分期期、穿刺次数3 次、化疗次数5 次、导管留置时间6 个月、敷料更换频率7 d/次比例和血清 CRP、PCT 水平更高（P0.05）。多因素 Logistic 回归分析显示，糖尿病、TNM 分期期、化疗次数5 次、导管留置时间6 个月、敷料更换频率7 d 更换 1 次、CRP（较高）、PCT（较高）为乳腺癌患者术后 PICC 导管相关性感染的危险因素（P0.05）。ROC 曲线分析显示，血清 CRP、PCT 水平联合预测乳腺癌患者术后 PICC 导管相关性感染的曲线下面积（AUC）大于单独预测。结论：糖尿病、TNM 分期、化疗次数、导管留置时间、敷料更换频率、血清 CRP、PCT与乳腺癌患者术后 PICC 导管相关性感染相关，置管前血清 CRP、PCT 水平联合预测乳腺癌患者术后 PICC 导管相关性感染发生风险的价值较高。关键词：乳腺癌；PICC 导管相关性感染；危险因素；C 反应蛋白；降钙素原；预测价值中图分类号：R737.9文献标识码：A文章编号：1673-6273（2023）02-289-05Risk Factors of Postoperative PICC Catheter-Related Infection in Patientswith Breast Cancer and the Predictive Value of Serum C-Reactive Proteinand Procalcitonin on the Risk of Infection*ZHOU Yuan1,LUO Yu1,HU Lin-lin1,LU Na2,JIANG Ying3(1 Breast and Thyroid Surgery,Peoples Hospital of Wuhan University,Wuhan,Hubei,430060,China;2 Surgery of Liver,Gallbladder,Nail and Breast,Wuhan Fourth Hospital,Wuhan,Hubei,430030,China;3 Department of Oncology,Peoples Hospital of Wuhan University,Wuhan,Hubei,430060,China)ABSTRACT Objective:To analyze the risk factors of postoperative peripherally inserted central catheters(PICC)-related fection inpatients with breast cancer and to explore the predictive value of serum C-reactive protein(CRP)and procalcitonin(PCT)on the risk ofinfection.Methods:150 patients with breast cancer who received PICC catheterization after modified radical mastectomy in our hospitalfrom January 2019 to January 2022 were selected.According to whether there was PICC catheter-related infection,they were dividedinto 34 cases in the infection group and 116 cases in the non-infection group.The clinical data of patients were collected,and the levelsof serum CRP and PCT before catheterization were detected by chemiluminescence.The risk factors of PICC catheter-related infection inpatients with breast cancer were analyzed by univariate and multivariate Logistic regression,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of the levels of serum CRP and PCT alone and in combination for postoperativePICC catheter-related infection in patients with breast cancer.Results:Univariate analysis showed that compared with the non-infectiongroup,the infection group had higher proportions of hypertension,dypertension,TNM stage,puncture times 3 times,chemotherapytimes 5 times,catheter retention time 6 months,dressing change frequency 7 d/time and the levels ofserum CRP and PCT(P0.05).Multivariate Logistic regression analysis showed that diabetes mellitus,TNM stage,chemotherapy times 5 times,catheter retentiontime 6 months,dressing change frequency 7 d replaced 1 time,CRP(higher),PCT(higher)were the risk factors for postoperativePICC catheter-related infection in patients with breast cancer(P0.05).ROC curve analysis showed that the area under curve(AUC)of*基金项目：湖北省自然科学基金项目（2020CFA026）作者简介：周媛（1991-），女，在读硕士研究生，主要从事乳甲外科方向的研究，E-mail:Y（收稿日期：2022-05-28 接受日期：2022-06-24）289现代生物医学进展Progress in Modern Biomedicine Vol.23NO.2JAN.2023postoperative PICC catheter-associated infection predicted by serum CRP and PCT levels combined was greater than that predictedalone.Conclusion:Diabetes mellitus,TNM stage,chemotherapy times,catheter retention time,dressing change frequency,serum CRPand PCT are associated with postoperative PICC catheter-associated infections in patients with breast cancer,and the combined serumCRP and PCT levels before catheterization have a high value in predicting the risk of postoperative PICC catheter-related infection inpatients with breast cancer.Key words:Breast cancer;PICC catheter-related infection;Risk factors;C-reactive protein;Procalcitonin;Predictive ValueChinese Library Classification(CLC):R737.9Document code:AArticle ID:1673-6273(2023)02-289-05前言乳腺癌是全球女性最常见和死亡率最高的恶性肿瘤，最新统计数据显示，2020 年全球乳腺癌发病和死亡例数分别为226.1 万例、68.5 万例，我国乳腺癌发病和死亡例数分别为 41.6万例、11.7 万例1。目前手术联合化疗是乳腺癌常用治疗方式，但由于化疗药物的高浓度、酸碱性、化学性，常规周围血管穿刺或套管针给药极易破坏血管，引起不可逆的血管损伤，反复多次静脉穿刺和化疗药物的毒性反应也会加重血管损伤2,3。经外周静脉置入中心静脉导管（peripherally inserted central venouscatheter，PICC）建立的静脉给药通道有利于化疗药物的安全性，已被广泛应用于乳腺癌治疗，具有操作简便、疼痛轻、反复穿刺少等优势4,5，但 PICC 使用过程中极易因多种因素引起并发症，增加非预期拔管几率和再次置管难度。导管相关性感染是 PICC 置管常见并发症，严重降低患者治疗依从性、延长住院时间、增加住院费用，反复感染可能导致患者死亡6,7。因此，早期评估 PICC 导管相关性感染风险对改善患者预后和减轻经济负担十分重要。C 反应蛋白（C-reactive protein，CRP）、降钙素原（procalcitonin，PCT）是临床常见的非特异性感染指标8，因此，本研究拟分析乳腺癌患者术后 PICC 导管相关性感染的危险因素，并探讨血清 CRP、PCT 对感染风险的预测价值，报道如下。1 资料与方法1.1 一般资料选取 2019 年 1 月2022 年 1 月我院收治的 150 例术后接受 PICC 置管的乳腺癌患者，年龄 286