假丝酵母定植对乳腺癌术后细菌性呼吸机相关性肺炎的影响及机制  

Influence of Candida colonization on postoperative bacterial ventilator-associated pneumonia in breast cancer patients and its mechanisms

作　　者：田艳春[1] 聂培兰[1] 董传英 高静[1] 霍明桐 TIAN Yan-chun;NIE Pei-lan;DONG Chuan-ying;GAO Jing;HUO Ming-tong(Jinan Fourth People's Hospital,Jinan,Shandong 25003l,China)

机构地区：[1]济南市第四人民医院手术室,山东济南250031 [2]济南市第四人民医院麻醉科,山东济南250031

出　　处：《中华医院感染学杂志》2023年第5期747-751,共5页Chinese Journal of Nosocomiology

基　　金：山东省科研基金资助项目(2020K0210)。

摘　　要：目的探究呼吸道假丝酵母定植对乳腺癌术后并发细菌性呼吸机相关性肺炎(VAP)的影响及机制。方法回顾性分析2020年8月-2021年8月于济南市第四人民医院行乳腺癌根治术的128例患者的临床资料,根据是否并发VAP分为感染组27例和未感染组101例,根据假丝酵母定植结果分成定植组55例和未定植组73例。酶联免疫吸附法检测血清白细胞介素-6(IL-6)、IL-1β、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)和降钙素原(PCT)水平;实时荧光定量PCR(qRT-PCR)检测miR-146a、Toll样受体4(TLR4)和核转录因子-κB(NF-κB)表达。结果感染组患者27例,共检出28株细菌,以革兰阴性菌为主。感染组呼吸道假丝酵母阳性率高于未感染组且存在多种假丝酵母定植。定植组患者IL-1β、IL-6、TNF-α、CRP、PCT水平高于未定植组(P<0.05)。定植组患者miR-146a、TLR4 mRNA和NF-κB mRNA水平高于未定植组(P<0.05)。结论呼吸道假丝酵母定植会增加细菌性VAP发生率,可能通过激活miR-146a、TLR4和NF-κB等的表达促进炎症因子释放,诱导细菌性VAP发生发展。OBJECTIVE To explore the influence of respiratory tract colonization of Candida on postoperative bacterial ventilator-associated pneumonia(VAP)in breast cancer patients and observe its mechanisms.METHODS Totally 128 patients who underwent radical mastectomy in Jinan Fourth People′s Hospital from Aug 2020 to Aug 2021 were enrolled in the study and divided into the infection group with 27 cases and the no-infection group with 101 cases according to the status of complication with VAP,the clinical data of the enrolled patients were retrospectively analyzed.The patients were divided into the colonization group with 55 cases and the no colonization group with 73 cases according to the result of Candida colonization.The levels of serum interleukin-6(IL-6),IL-1β,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and procalcitonin(PCT)were detected by means of enzyme-linked immunosorbent assay;the expressions of miR-146a,Toll like receptor 4(TLR4)and nuclear factor-κB(NF-κB)TLR4 were detected by real-time fluorescent quantitative PCR(qRT-PCR).RESULTS Totally 28 strains of bacteria were isolated from the 27 patients of the infection group,among which gram-negative bacteria were dominant.The positive rate of respiratory tract Candida of the infection group was higher than that of the no infection group,with multiple species of Candida colonized.The levels of IL-1β,IL-6,TNF-α,CRP and PCT of the colonization group were higher than those of the no colonization group(P<0.05).The expression levels of miR-146a,TLR4 mRNA and NF-κB mRNA of the colonization group were higher than those of the no colonization group(P<0.05).CONCLUSION The colonization of respiratory tract Candida may lead to the increase of bacterial VAP,promote the release of inflammatory factors by activating the expressions of miR-146a,TLR4 and NF-κB,and induce the occurrence and development of bacterial VAP.

关 键 词：呼吸道假丝酵母定植 乳腺癌根治术 细菌性呼吸机相关性肺炎 丝/苏氨酸激酶/核转录因子κB 实时荧光定量PCR 

分 类 号：R737.9[医药卫生—肿瘤]