老年肺癌化疗合并肺部感染致病菌分布及免疫功能指标变化  

Distribution of pathogenic bacteria and changes in immune function indicators in elderly patients with lung cancer complicated by chemotherapy and pulmonary infection

作　　者：李秋波 刘瑛 谭婷 LI Qiubo;LIU Ying;TAN Ting(Department of Oncology,Hubei Jingmen Central Hospital,Jingmen 448000,Hubei,China;Department of Gastroenterology,Hubei Jingmen Central Hospital)

机构地区：[1]湖北荆门中心医院肿瘤科,湖北荆门448000 [2]湖北荆门中心医院消化内科

出　　处：《中国病原生物学杂志》2024年第8期958-962,共5页Journal of Pathogen Biology

基　　金：荆门市科学技术研究与开发计划引导项目(No.2023YDKY095);荆门市一般科技项目(No.2023YFYB102)。

摘　　要：目的 分析老年肺癌化疗合并肺部感染患者致病菌分布情况及免疫功能指标变化特点。方法 选取本院肿瘤科接诊的178例老年肺癌化疗合并肺部感染(感染组)及90例未发生肺部感染患者(对照组)为本研究对象。采集呼吸系统分泌物标本进行致病菌鉴定,对比两组患者外周血免疫球蛋白水平。对培养分离的肺炎克雷伯菌与大肠埃希进行药敏试验,同时检测耐药基因的携带情况。结果 感染组检出178株致病菌,革兰阳性菌45株(占25.28%),主要为肺炎链球菌(10.11%,18/178)和金黄色葡萄球菌(5.62%,10/178);革兰阴性菌117株(占65.73%),主要为肺炎克雷伯菌(26.40%,47/178)和大肠埃希菌(19.66%,35/178);真菌16株(占8.99%),主要为白色假丝酵母菌(4.49%,8/178)和热带假丝酵母菌(2.81%,5/178)。肺部感染组患者外周血IgA、IgG、IgM水平均显著低于对照组患者(P<0.05)。47株肺炎克雷伯菌检出产超广谱β-内酰胺酶菌18株,35株大肠埃希菌检出产超广谱β-内酰胺酶菌19株。产超广谱β-内酰胺酶肺炎克雷伯菌对哌拉西林、头孢呋辛、头孢他啶、头孢曲松、头孢吡肟、头孢哌酮/舒巴坦、美罗培南、亚胺培南、环丙沙星、莫西沙星、庆大霉素、阿米卡星的耐药率均高于未产超广谱β-内酰胺酶肺炎克雷伯菌(P<0.05)。产超广谱β-内酰胺酶大肠埃希菌与未产超广谱β-内酰胺酶大肠埃希菌对亚胺培南、阿米卡星的耐药率差异无统计学意义(P>0.05),对哌拉西林、头孢呋辛、头孢他啶、头孢曲松、头孢吡肟、头孢哌酮/舒巴坦、美罗培南、环丙沙星、莫西沙星、庆大霉素的耐药率差异有统计学意义(P<0.05)。18株产超广谱β-内酰胺酶肺炎克雷伯菌中,CTX-M基因携带率为77.78%(14/18),SHV基因携带率为44.44%(8/18),TEM基因携带率为22.22%(4/18)。7株同时携带两种及两种以上耐药基因,其中3株携带CTX-M+SHV基因,2株携带CTX-M+TEM基因,1株携带SHV+TEM基�Objective To analyze the distribution of pathogenic bacteria and changes in immune function indicators in elderly patients with lung cancer complicated by chemotherapy and pulmonary infection. Methods 178 elderly patients with lung cancer complicated by chemotherapy and pulmonary infection(infection group),as well as 90 patients without pulmonary infection(control group),who were admitted to the oncology department of our hospital, were selected as the study subjects.The respiratory secretion samples were collected for pathogen identification, and the peripheral blood immunoglobulin levels between two groups of patients were compared. The drug sensitivity tests of cultured and isolated Klebsiella pneumoniae and Escherichia coli were conducted, while the carrying status of resistance genes were detected. Results 178 pathogenic bacteria were detected in the infection group. including 45 strains(25.28%) of Gram positive bacteria, mainly Streptococcus pneumoniae(10.11%,18/178) and Staphylococcus aureus(5.62%,10/178);117 strains(65.73%) of Gram negative bacteria, mainly K. pneumoniae(26.40%,47/178) and E. coli(19.66%,35/178);16 strains(8.99%) of Fungi, mainly composed of Candida albicans(4.49%,8/178) and Candida tropicalis(2.81%,5/178). The levels of IgA,IgG,and IgM in the peripheral blood of patients with pulmonary infection were significantly lower than those of the control group(P<0.05). A total of 47 strains of K. pneumoniae were detected, including 18 strains of ESBLs producing K. pneumoniae. A total of 35 strains of Escherichia coli were detected, including 19 strains of ESBLs producing Escherichia coli. The resistance rates of ESBLs producing K. pneumoniae to piperacillin, cefuroxime, ceftazidime, ceftriaxone, cefepime, cefoperazone/sulbactam, meropenem, imipenem, ciprofloxacin, moxifloxacin, gentamicin, and amikacin were higher than those of non ESBLs producing K. pneumoniae,and the difference was statistically significant(P<0.05). There was no statistically significant difference in the resistance rates of ES

关 键 词：肺癌化疗 肺部感染 致病菌 免疫功能 耐药基因 

分 类 号：R446.5[医药卫生—诊断学] R734.2[医药卫生—临床医学] R563.1