铜绿假单胞菌AECOPD并发感染患者分离株的耐药性及其对气道炎症损伤的机制  

Drug resistance of Pseudomonas aeruginosa isolates from AECOPD patients complicated with infection and its mechanisms on airway inflammation damage

作　　者：吴亚楠 林青青 贾贝丽[3] 王亚菲 林晓彤 WU Ya-nan;LIN Qing-qing;JIA Bei-i;WANG Ya-fei;LIN Xiao-tong(Qingdao Municipal Hospital,Qingdao,Shandong 266000,China)

机构地区：[1]青岛市市立医院东院区保健一科,山东青岛266000 [2]青岛市市立医院呼吸与危重症一科,山东青岛266000 [3]青岛市市立医院东院区保健五科,山东青岛266000

出　　处：《中华医院感染学杂志》2023年第8期1127-1131,共5页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(Y20120C16)。

摘　　要：目的探究慢性阻塞性肺疾病急性加重期(AECOPD)患者铜绿假单胞菌(PA)感染的耐药性,分析PA感染对患者气道炎症损伤的可能机制。方法选取2018年9月-2021年9月青岛市市立医院收治的AECOPD合并PA呼吸道感染患者42例为PA感染组,以同期AECOPD未发生PA感染的患者43例为未感染组,分析PA菌株耐药性,酶联免疫吸附法检测患者气道炎症相关因子水平、血清白细胞介素(IL)-1β和环氧化酶-2(COX-2)水平,实时荧光定量聚合酶链反应(PCR)法检测单个核细胞IL-1β、COX-2相关mRNA表达水平。结果42株PA分离菌株对常用抗菌药物均存在一定的耐药性,对左氧氟沙星、磺胺甲噁唑/甲氧苄啶、环丙沙星和氨苄西林/舒巴坦的耐药率>70%,对头孢他啶、阿米卡星等具有一定敏感性。PA感染组第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FEV1/FVC)和CD8+水平低于未感染组,COPD自我评估测试(CAT)评分和改良英国医学研究理事会呼吸困难指数量表(mMRC)评分高于未感染组(P<0.05)。PA感染组血清IL-8、IL-6和肿瘤坏死因子-α(TNF-α)水平高于未感染组,血清IL-10水平低于未感染组(P<0.05)。PA感染组血清IL-1β、COX-2水平高于未感染组,IL-1βmRNA、COX-2 mRNA相对表达量高于未感染组(P<0.05)。结论AECOPD患者PA感染的病原菌耐药性具有一定特征性,合并PA感染可能加重AECOPD患者的COPD病情严重程度和气道炎症损伤,影响患者气道炎症因子水平,其相关机制可能与IL-1β/COX-2信号通路有关。OBJECTIVE To explore the drug resistance of Pseudomonas aeruginosa(PA)infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and analyze the possible mechanism of PA infection in airway inflammation.METHODS A total of 42 patients with AECOPD and PA infection(PA infection group)and 43 patients with AECOPD without PA infection(non-infection group)admitted to the Qingdao Municipal Hospital from Sep 2018 to Sep 2021 were included in this study.Drug resistance of PA strains was analyzed.The levels of airway inflammation related factors,serum interleukin(IL-1β)and cyclooxygenase-2(COX-2)were detected by enzyme-linked immunosorbent assay.The mRNA expression levels of IL-1βand COX-2 were detected by real-time fluorescent quantitative polymerase chain reaction(PCR).RESULTS The 42 PA strains isolated were drug-resistant to commonly used antibiotics.The drug resistance rates to levofloxacin,sulfamethoxazole/trimethoprim,ciprofloxacin and ampicillin/sulbactam were higher than 70%,while the strains were sensitive to ceftazidime and amikacin.Forced expiratory volume in 1 second(FEV1),FEV1/forced vital capacity(FEV1/FVC)and CD_8~+level in the PA infection group were lower than those in the no infection group;the COPD assessment test(CAT)scores and modified British medical research council(mMRC)scores were higher than those in the no infection group(P<0.05).The levels of serum IL-8,IL-6 and tumor necrosis factor-α(TNF-α)in the PA infection group were higher than those in the no infection group,and the level of IL-10 was lower than that in the non-infection group(P<0.05).The levels of serum IL-1βand COX-2 in the PA infection group were higher than those in the no infection group,and the relative expression levels of IL-1βmRNA and COX-2 mRNA were higher than those in the no infection group(P<0.05).CONCLUSION Drug resistance of pathogenic bacteria in patients with AECOPD and PA infection is characteristics.PA infection may aggravate COPD and airway inflammation in patients with AECOPD,a

关 键 词：慢性阻塞性肺疾病急性加重期 铜绿假单胞菌 感染 气道炎症 白细胞介素-1Β 环氧化酶-2 

分 类 号：R563[医药卫生—呼吸系统]