脓毒症肺内感染与肺外感染ARDS肺部微生态的异同  

Comparison of lung microbiome between ARDSp and ARDSexp caused by sepsis

作　　者：张鹏[1] 刘升明[2] 刘宝仪 张爽[1] 张鑫[3] 黄炎明[4] ZHANG Peng;LIU Sheng-ming;LIU Bao-yi;ZHANG Shuang;ZHANG Xin;HUANG Yan-ming(Department of Critical Medicine,Jiangmen Central Hospital,Jiangmen 529030,Guangdong,China;不详)

机构地区：[1]江门市中心医院重症医学科,广东江门529030 [2]暨南大学附属第一医院呼吸与危重医学科,广东广州510630 [3]江门市中心医院医学研究中心,广东江门529030 [4]江门市中心医院呼吸与危重医学科,广东江门529030

出　　处：《广东医学》2022年第3期356-361,共6页Guangdong Medical Journal

基　　金：广东省医学科学技术研究基金项目(A2022089);广东省自然科学基金资助项目(2019A1515011565);江门市科技计划项目(2019030102430012905);江门市中心医院科研杰青项目(J202004)。

摘　　要：目的探讨起始感染部位不同的脓毒症导致急性呼吸窘迫综合征(ARDS)患者肺部微生态的差异,寻找肺内感染与肺外感染ARDS肺部微生态的变化规律。方法收集在ICU收治的脓毒症导致ARDS的病例。根据起始感染情况将患者分为肺内感染导致的ARDS(ARDSp)81例(ARDSp组),肺外感染导致的ARDS(ARDSexp)25例(ARDSexp组)和非ARDS患者作为对照(对照组)25例。分析比较3组患者基线水平的支气管肺泡灌洗液(BALF)的宏基因二代测序(mNGS)结果,探讨ARDSp和ARDSexp肺部微生态的异同。结果病原微生物方面,ARDSp组的病原微生物多样,包含细菌、真菌、病毒、特殊病原体,而ARDSexp组虽原发感染灶不在肺部,但可能由于菌群移位,出现大肠埃希菌的增多。背景菌方面,ARDSp组比对照组的阳性率减少,减少的菌群可能为呼吸道正常菌群;而ARDSexp组比对照组和ARDSp组的阳性率同时增加,增加的菌群是条件致病菌和肠道菌群。结论ARDSp患者肺内微生态的特征是病原微生物的增加及正常呼吸道菌群的减少,导致菌群多样性减少;而ARDSexp患者肺内微生态的特征是条件致病菌和肠道菌群的增加,导致菌群多样性的增加。Objective To investigate the differences in clinical information as well as pulmonary microecology of acute respiratory distress syndrome(ARDS)patients with different etiologies,and to investigate the changing pattern of lung microbiome in ARDS patients caused by sepsis.Methods The cases with ARDS caused by sepsis admitted to the ICU were studied.According to the initial infection status,there were 81 ARDS patients originating from pulmonary diseases(ARDSp group),25 ARDS patients originating from extrapulmonary diseases(ARDSexp group)and 25 Non-ARDS patients(control group).The clinical information of ARDS patients and next-generation sequencing(mNGS)results of bronchoalveolar lavage fluid(BALF)samples were collected to analyze the differences in lung microbiome between ARDSp and ARDSexp.Results In pathogenic micro-organisms analysis,the pathogenic micro-organisms in ARDSp group were diverse,including bacteria,fungi,viruses and special pathogens.Although the primary infection focus in ARDSexp group was not in the lung,the increase of Escherichia coli was observed which possibly due to the shift of flora.In background bacteria analysis,the positive rate of ARDSp group was lower than that of control group,and the reduced flora may be normal flora in respiratory tract.The positive rate in ARDSexp group was increased compared with ARDSp group and control group,and the increased flora included opportunistic pathogens and intestinal flora.Conclusion The pulmonary microecology in patients with ARDSp is characterized by an increase in pathogenic microorganisms and a reduction in the flora of the normal respiratory tract,resulting in a reduction in flora diversity.The pulmonary microecology in patients with ARDSexp is characterized by the increase of opportunistic pathogens and intestinal flora,resulting in the increase of flora diversity.

关 键 词：急性呼吸窘迫综合征 脓毒症 肺部微生态 肺内源性ARDS 肺外源性ARDS 

分 类 号：R37[医药卫生—病原生物学] R563[医药卫生—基础医学]