老年患者多药耐药铜绿假单胞菌肺部感染危险因素和辅助性T细胞17及调节性T细胞表达水平  

Risk factors for multidrug-resistant Pseudomonas aeruginosa pulmonary infection and expressions of helper T cell 17,regulatory T cell in elderly patients

作　　者：安霞 高英华 孟玲 魏丽 AN Xia;GAO Ying-hua;MENG Ling;WEI Li(The Second Affiliated Hospital of Shandong First Medical University,Tai'an,Shandong 271000,China)

机构地区：[1]山东第一医科大学第二附属医院呼吸科,山东泰安271000

出　　处：《中华医院感染学杂志》2023年第9期1294-1297,共4页Chinese Journal of Nosocomiology

基　　金：山东省科技计划项目(2018M269132)。

摘　　要：目的探讨老年多药耐药铜绿假单胞菌肺部感染危险因素和辅助性T细胞17(Th17)及调节性T细胞(Treg)表达。方法选择2019年1月-2021年11月山东第一医科大学第二附属医院收治的老年铜绿假单胞菌肺部感染患者166例为研究对象,根据铜绿假单胞菌是否多药耐药(MDRO)分为MDRO组48例与非MDRO组118例,同期选择100名健康体检人群为对照组。检测Th17细胞、Treg细胞占CD_(4)^(+)T细胞的比例、白细胞介素(IL)-10、IL-17A表达水平。多因素Logistic回归分析老年患者多药耐药铜绿假单胞菌肺部感染危险因素;采用受试者工作特征(ROC)曲线分析模型的预测价值。结果多因素分析结果显示,气管插管、碳青霉烯类暴露、抗菌药物使用种类≥3种、Th17细胞及IL-17A高表达、Treg细胞及IL-10低表达是老年患者多药耐药铜绿假单胞菌肺部感染的危险因素(P<0.05);根据危险因素构建的回归方程模型,预测患者多药耐药铜绿假单胞菌肺部感染ROC曲线下面积(AUC)为0.896(95%CI:0.815~0.976),灵敏度为92.8%,特异度为86.6%。结论老年铜绿假单胞菌肺部感染患者发生多药耐药与侵入性操作、抗菌药物使用种类多、Th17/Treg免疫失衡相关,多个危险因素联合对预测多药耐药发生有较高的价值。OBJECTIVE To explore the risk factors for multidrug-resistant Pseudomonas aeruginosa pulmonary infection and observe the expressions of helper T cell 17(Th17)and regulatory T cell(Treg)in the elderly patients.METHODS A total of 166 elderly patients with P.aeruginosa pulmonary infection who were treated in the Second Affiliated Hospital of Shandong First Medical University from Jan 2019 to Nov 2021 were recruited as the research subjects and were divided into the MDRO group with 48 cases and the non-MDRO group with 118 cases according to the fact whether the strains were multidrug-resistant organism(MDRO).Meanwhile,100 healthy people who received physical examination were chosen as the control group.The percentages of Th17 cell and Treg cell in CD_(4)^(+)T cells,expression levels of interleukin(IL)-10 and IL-17A were detected.Multivariate logistic regression analysis was performed for the risk factors for the multidrug-resistant P.aeruginosa pulmonary infection in the elderly patients.The predictive value of the model was analyzed by means of receiver operating characteristic(ROC)curve.RESULTS The result of multivariate analysis showed that the endotracheal intubation,exposure to carbapenemases,use of no less than 3 types of antibiotics,high expressions of Th17 cell and IL-17A,and low expressions of Treg cell and IL-10 were the risk factors for the multidrug-resistant P.aeruginosa pulmonary infection in the elderly patients(P<0.05).The regression equation model was established based on the risk factors,and the area under curve(AUC)was 0.896(95%CI:0.815-0.976)in prediction of multidrug-resistant P.aeruginosa pulmonary infection,with the sensitivity 92.8%,the specificity 86.6%.CONCLUSION The multi-drug resistance of the elderly patients with P.aeruginosa pulmonary infection is associated with the invasive operation,use of multiple types of antibiotics and Th17/Treg immune imbalance.The combination of the multiple risk factors may have high value in prediction of multi-drug resistance.

关 键 词：多药耐药菌 铜绿假单胞菌 老年 肺炎 危险因素 辅助性T细胞17 调节性T细胞 预测价值 

分 类 号：R563[医药卫生—呼吸系统]