大环内酯类药物联合阿米卡星对支气管扩张患者PA形成生物膜的清除作用  

Effects of macrolides and amikacin on eradicating Pseudomonas aeruginosa biofilms in bronchiectasis patients

作　　者：张艳芳[1] 冯广满 ZHANG Yan-fang;FENG Guang-man(Department of Clinical Laboratory, Huangpu District People＇s Hospital of Zhongshan , Zhongshan , Guangdong 528429, Chin)

机构地区：[1]广东省中山市黄圃人民医院检验科,广东中山528429

出　　处：《热带医学杂志》2017年第12期1593-1596,共4页Journal of Tropical Medicine

基　　金：中山市医学科研项目(2016A020227)

摘　　要：目的探讨大环内酯类药物联合阿米卡星(AMK)在清除支气管扩张患者感染粘液型铜绿假单胞菌(PA)生物膜的作用及其机制,以期更好地指导临床用药。方法收集分离支气管扩张患者痰液中的PA进行培养,体外建立生物膜模型,连续稀释法进行菌落计数,分析大环内酯类药物和AMK对PA生物膜的清除作用,同时检测不同抗生素对PA致病因子藻酸盐、蛋白水解酶和绿脓菌素的抑制作用。结果单独应用大环内酯类药物红霉素(EM)、罗红霉素(ROX)和克拉霉素(CAM)对清除PA生物膜无作用,AMK单独使用的作用也不明显,而联合应用大环内酯类药物能显著增强AMK对PA生物膜的清除作用,且清除作用具有时间依赖性,差异有统计学意义(P<0.05)。同时,单独使用大环内酯类抗生素和AMK均能抑制藻酸盐的分泌,而单独使用大环内酯类对蛋白水解酶和绿脓菌素的抑制作用则不明显,差异无统计学意义(P>0.05);联合应用大环内酯类和AMK能显著抑制蛋白水解酶和绿脓菌素的分泌,差异有统计学意义(P<0.05)。结论大环内酯类药物联合AMK对支气管扩张患者PA形成的生物膜有显著的清除作用,其机制可能为抑制致病因子藻酸盐、蛋白水解酶和绿脓菌素的分泌。Objective To investigate the effects and mechanism of macrolides combined with amikacin on eradicating Pseudomonas aeruginosa （PA） biofilms in bronchiectasis patients, and guide clinical medication. Methods PA was obtained from the sputum of bronchiectasis patients to prepare the PA biofilms in vitro. The biofilms were treated with macrolides and amikacin to study the eradicating effects by serially diluted method. The inhibitory effects of different antimicrobial agents on PA pathogenic factors alginate, proteolytic enzymes and pyocyanin were detected. Results Macrolides used alone failed to eradicating PA biofilms but enhanced the effects of amikacin when used in combination （P〈 0.05）. In addition, they could decrease the level of alginate, proteolytic enzyme and pyocyanine dramatically when compared with single-drug treatment （P〈0.05）. Conclusion Macrolides combination with amikacin showed synergetic effects against PA biofilms ; the inhibition of pathogenic factor could be the underlying mechanism.

关 键 词：大环内酯类 阿米卡星 支气管扩张 铜绿假单胞菌 生物膜 

分 类 号：R562.22[医药卫生—呼吸系统] R378.991[医药卫生—内科学]