重症肺炎患者多药耐药菌感染病原学及NETs和IL-17与TGF-β诊断价值  

Etiological characteristics of multidrug-resistant organisms infections in patients with severe pneumonia and diagnostic values of NETs,IL-17 and TGF-β

作　　者：李星 叶林 赵磊 万政伟 刘星 邱竞 关华 LI Xing;YE Lin;ZHAO Lei;WAN Zheng-wei;LIU Xing;QIU Jing;GUAN Hua(Sichuan Provincial People's Hospital,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu,Sichuan 610031,China)

机构地区：[1]电子科技大学附属医院·四川省人民医院健康管理中心,四川成都610031 [2]电子科技大学附属医院·四川省人民医院院长办公室,四川成都610031 [3]电子科技大学附属医院·四川省人民医院老年呼吸科,四川成都610031

出　　处：《中华医院感染学杂志》2024年第7期973-977,共5页Chinese Journal of Nosocomiology

基　　金：四川省科技计划基金资助项目(2023JDRC0105)。

摘　　要：目的探讨重症肺炎(SP)患者多药耐药菌(MDRO)感染的病原学及中性粒细胞胞外网状陷阱(NETs)、白细胞介素-17(IL-17)、转化生长因子-β(TGF-β)诊断价值。方法回顾性分析2019年6月-2023年3月四川省人民医院收治176例SP患者的临床资料,根据所选患者是否发生MDRO感染将其分为未感染组(102例)和感染组(74例)。分析感染组病原学特点,比较两组临床资料、NETs、IL-17、TGF-β,NETs、IL-17、TGF-β对SP患者MDRO感染的诊断价值采用受试者工作特征(ROC)曲线进行分析。结果74例感染组患者中分离出MDRO株98株,革兰阳性菌的占比为34.69%,革兰阴性菌的占比为65.31%;感染组医院获得性肺炎、有创机械通气、有碳青霉烯类药物使用、≥3种抗菌药物联用的患者占比均高于未感染组(P<0.05);感染组血清NETs、IL-17水平均高于未感染组,血清TGF-β水平低于未感染组(P<0.05);NETs、IL-17、TGF-β及联合检测诊断SP患者MDRO感染的曲线下面积(AUC)分别为0.629、0.684、0.649、0.886,敏感度分别为64.86%、66.22%、62.16%、79.73%,特异度分别为66.67%、66.67%、68.63%、89.22%,其中联合检测的AUC、敏感度、特异度最高(P<0.05)。结论SP患者MDRO中鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌的占比较高,而MDRO感染可能与患者疾病类型、有创机械通气、碳青霉烯类药物使用、抗菌药物联用等因素有关,且血清NETs、IL-17、TGF-β水平变化与MDRO感染具有密切关系,三者联合检测的诊断价值较高,可为临床诊治提供有效参考依据,临床可据此给予针对性地预防及抗菌药物治疗,以促进治疗效果。OBJECTIVE To investigate the etiological characteristics,drug resistance,and diagnostic value of neu-trophil extracellular reticular trap(NETs),interleukin-17(IL-17)and transforming growth factor-β(TGF-β)in patients with severe pneumonia(SP)with multi-drug resistant bacteria(MDRO).METHODS The clinical data of 176 patients with SP admitted to Sichuan Provincial People's Hospital from Jun 2019 to Mar 2023 were retrospec-tively analyzed.The selected patients were divided into the uninfected group(102 cases)and infected group(74 ca-ses)according to whether they had multidrug-resistant bacteria infection.The pathogenic characteristics in the in-fection group were analyzed,and clinical data,NETs,IL-17 and TGF-βwere compared between the two groups.The diagnostic value of NETs,IL-17 and TGF-βin MDRO infection in patients with SP was analyzed by receiver operating characteristic(ROC)curve.RESULTS Among the 74 infected patients,98 MDRO were isola-ted,gram-positive bacteria accounting for 34.69%and gram-negative bacteria accounting for 65.31%.The pro-portion of patients with nosocomial pneumonia,invasive mechanical ventilation,carbapenem use,and three or more combined antibacterial agents use in the infected group were higher than that in the uninfected group(P<0.05).The levels of serum NETs and IL-17 in the infection group were higher than those in the uninfected group,while the level of serum TGF-βwere lower than that in the uninfected group(P<0.05).The area under curve(AUC)of NETs,IL-17,TGF-βindividual and combined detection for the diagnosis of MDRO infection in patients with SP were 0.629,0.684,0.649 and 0.886,respectively,with the sensitivity of 64.86%,66.22%,62.16%and 79.73%,respectively.The specificity were 66.67%,66.67%,68.63%and 89.22%,respectively,and the AUC,sensitivity and specificity of combined detection were the highest(P<0.05).CONCLUSION The propor-tion of Acinetobacter baumannii,Pseudomonas aeruginosa,and Klebsiella pneumoniae of MDRO strains in SP patients is relatively high.Risk factors of MDRO inf

关 键 词：重症肺炎 多药耐药菌 病原学 耐药性 中性粒细胞胞外网状陷阱 白细胞介素-17 转化生长因子-Β 

分 类 号：R563.1[医药卫生—呼吸系统]