呼吸内科住院老年患者医院真菌感染病原菌特点及Th17/Treg变化  

Etiological characteristics of nosocomial fungal infections in elderly patients hospitalized in respiratory medicine department and change of Th17/Treg

作　　者：史广超 刘晶 刘鑫 邢亚恒 杨小静 薛夏 SHI Guang chao;LIU Jing;LIU Xin;XING Ya-heng;YANG Xiao-jing;XUE Xia(Xuchang Central Hospital.Xuchang,Henan 461000,China)

机构地区：[1]许昌市中心医院呼吸科二病区,河南许昌461000

出　　处：《中华医院感染学杂志》2020年第14期2100-2104,共5页Chinese Journal of Nosocomiology

基　　金：河南省自然科学基金资助项目(2019342)。

摘　　要：目的探讨呼吸内科住院老年患者医院真菌感染病原分布特点及Th17/Treg细胞及细胞因子变化。方法选择许昌市中心医院2016年1月-2019年9月呼吸内科住院老年患者132例作为研究对象,根据其在住院期间是否合并真菌感染分为感染组(n=60)和非感染组(n=72),对感染组患者病原分布特点及两组患者辅助型T细胞17(Th17)、调节型T细胞(Treg)及血清中白介素(IL)-17、IL-23、转化生长因子-β(TGF-β)、IL-35水平进行比较。结果 60例经病原培养确诊的感染组患者病原菌中假丝酵母属(56.67%)和曲霉菌属(25.00%)检出率最高;感染组老年患者Th17、Th17/Treg水平(5.13±1.51、0.13±0.04)低于非感染组(7.24±1.65、0.22±0.06),Treg(38.32±6.48)水平高于非感染组(33.25±5.94),差异具有统计学意义(P<0.05);感染组老年患者IL-17、IL-23水平分别为(5.35±2.56)pg/ml、(115.46±31.25) pg/ml低于非感染组(8.34±2.94)pg/ml、(135.74±36.54)pg/ml、TGF-β、IL-35水平分别为(42.21±12.34)pg/ml、(201.24±42.14) pg/ml高于非感染组(33.26±13.28) pg/ml、(183.15±39.39) pg/ml,差异具有统计学意义(P<0.05)。结论呼吸内科住院老年患者医院真菌感染以假丝酵母和曲霉菌为主,Th17/Treg免疫失衡是其入侵机体的重要途径,作为真菌感染免疫治疗及疫苗靶点有待进一步研究。OBJECTIVE To explore the distribution of pathogens causing fungal infections in elderly patients who were hospitalized in the department of respiratory medicine and observe the change of Th17/Treg and cytokines.METHODS A total of 132 elderly patients who were hospitalized the department of respiratory medicine from Jan 2016 to Sep 2019 were recruited as the study objects and divided into the infection group with 60 cases and the non-infection group with 72 cases according to the status of fungal infection during the hospital stay.The distribution of pathogens isolated from the infection group was observed,and the levels of helper T cell 17(Th17),regulatory T cell(Treg)and serum interleukin-17(IL-17),IL-23,transforming growth factor-β(TGF-β)and IL-35 were observed and compared between the two groups of patients.RESULTS Among the pathogens that were isolated from the 60 patients in the infection group,56.67%were Candida,and 25.00%were Aspergillus.The levels of Th17 and Th17/Treg of the infection group were respectively(5.13±1.51)and(0.13±0.04),significantly lower than(7.24±1.65)and(0.22±0.06)of the non-infection group.The Treg level of the non-infection group was(38.32±6.48),significantly higher than(33.25±5.94)of the non-infection group(P<0.05).The levels of IL-17 and IL-23 of the infection group were(5.35±2.56)pg/ml and(115.46±31.25)pg/ml,significantly lower than(8.34±2.94)pg/ml and(135.74±36.54)pg/ml of the non-infection group.The levels of TGF-βand IL-35 of the infection group were respectively(42.21±12.34)pg/ml and(201.24±42.14)pg/ml,significantly higher than(33.26±13.28)pg/ml and(183.15±39.39)pg/ml of the non-infection group(P<0.05).CONCLUSION Candida and Aspergillus are dominant among the pathogens causing fungal infections in the elderly patients of respiratory medicine department.Th17/Treg immune imbalance is an important way for their invasion of the body,and the vaccine targets need to be further studied.

关 键 词：呼吸内科 真菌感染 辅助型T细胞 调节型T细胞 

分 类 号：R519.3[医药卫生—内科学]