脓毒症肺外感染ARDS肺部微生物组的分析  

Analysis of lung microbiome in acute respiratory distress syndrome caused by septic extrapulmonary infection

作　　者：张鹏[1] 卢玉婷 吴镇涛 刘宝仪 郑伟浩 张鑫[2] 黄炎明[3] ZHANG Peng;LU Yu-ting;WU Zhen-tao;LIU Bao-yi;ZHENG Wei-hao;ZHANG Xin;HUANG Yan-ming(Critical Care Medicine,The Affiliated Jiangmen Hospital of Sun Yat-sen University,Jiangmen,Guangdong 529030,China;不详)

机构地区：[1]中山大学附属江门市中心医院重症医学科,广东江门529030 [2]中山大学附属江门市中心医院医学研究中心,广东江门529030 [3]中山大学附属江门市中心医院呼吸与危重症医学科,广东江门529030

出　　处：《中国微生态学杂志》2022年第8期948-952,共5页Chinese Journal of Microecology

基　　金：广东省医学科学技术研究基金项目(A2022089);江门市中心医院科研杰青项目(J202004)。

摘　　要：目的 分析比较脓毒症肺外感染导致的急性呼吸窘迫综合征(ARDS)患者不同预后的肺部微生组的基线水平的异同,尝试寻找肺部微生物组在ARDS疾病转归中的变化规律以及与预后相关的标志微生物。方法 收集2018年6月至2020年6月在江门市中心医院ICU收治的脓毒症肺外感染导致ARDS(ARDSexp)的病例55例和非ARDS患者对照组(Control组)25例。按照不同预后分为:存活组(ARDSexp-Survival组)20例和死亡组(ARDSexp-Dead组)35例。通过宏基因二代测序技术(mNGS)比较3组患者基线水平的支气管肺泡灌洗液间微生物的异同,尝试寻找与预后相关的标志微生物。结果 ARDSexp细菌负荷量增加。在病原微生物方面,发现大肠埃希菌(Escherichia coli)阳性检出率明显增加(P<0.05)。在背景菌方面,双歧杆菌属(Bifidobacterium)阳性检出率明显增加(P<0.05)。结论 脓毒症肺外感染ARDS肺部微生物组变化与患者预后密切相关,其中E.coli或双歧杆菌属(Bifidobacterium)的增加可能是ARDSexp死亡的危险因素。Objective To analyze and compare the changes in baseline levels of lung microbiome in patients with acute respiratory distress syndrome caused by septic extrapulmonary infection(ARDSexp) among different prognoses, and find out potential microbial markers related to prognosis. Methods Retrospective analysis was conducted on 55 cases of ARDSexp and 25 cases of non-ARDSexp(Control group) admitted to the ICU of our hospital from June 2018 to June 2020. According to the prognosis, the patients were divided into ARDSexp-Survival group(n=20) and ARDSexp-Death group(n=35). The metagenomics next-generation sequencing(mNGS) results of bronchoalveolar lavage fluid(BALF) were compared among groups, and the differences and similarities of lung microbiome in patients with different prognosis were analyzed to find out potential microbial markers related to prognosis. Results The bacterial loads in ARDSexp groups increased. In terms of pathogenic microorganisms, Escherichia coli significantly increased(P<0.05), while Bifidobacterium significantly increased as background bacteria(P<0.05). Conclusion The changes of pulmonary microbiome in patients with ARDSexp are closely related to the prognoses of patients. The increase of E.coli or Bifidobacterium may be the risk factors for the death of ARDSexp patients.

关 键 词：急性呼吸窘迫综合征 肺部微生物组 脓毒症 肺外感染 

分 类 号：R563[医药卫生—呼吸系统]