急性脑血管疾病合并肺部感染患者病原学特点及IL-23、IL-17预测价值分析  

Pathogenic characteristics of patients with acute cerebrovascular disease combined with pulmonar infection and Analysis of the predictive value of IL-23,IL-17

作　　者：张瑞[1] 王小雅 原野 孙敏妮 刘宏生 ZHANG Rui;WANG Xiaoya;YUAN Ye;SUN Minni;LIU Hongsheng(Department of Emergency Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院急诊医学科,河南郑州450052

出　　处：《中国病原生物学杂志》2024年第11期1354-1357,1362,共5页Journal of Pathogen Biology

摘　　要：目的探讨急性脑血管疾病合并肺部感染患者病原菌分布特点、耐药性及血清IL-23、IL-17预测价值,对临床制定治疗方案及早期诊断提供参考。方法选取本院接诊的235例急性脑血管疾病合并肺部感染患者及80例未发生肺部感染的急性脑血管疾病患者为本次研究对象。采集患者痰液标本,进行菌种鉴定及药敏试验。测定患者血清IL-23、IL-17水平,采用受试者工作特征曲线分析血清IL-23、IL-17水平对急性脑血管疾病合并肺部感染的预测价值。结果235例合并肺部感染患者中,46.81%为急性脑卒中(110/235),41.70%为急性脑出血(98/235),11.49%为其他急性脑血管疾病(27/235),共检出病原菌235株,为革兰阴性菌143株(60.85%),革兰阳性菌76株(32.34%),真菌16株(6.81%)。革兰阴性菌主要为肺炎克雷伯菌(48株,20.43%)和大肠埃希菌(40株,17.02%),铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽寡养单胞菌、流感嗜血杆菌、阴沟肠杆菌、奇异变形杆菌、产气肠杆菌、产酸克雷伯菌分别占8.94%、4.68%、2.55%、2.13%、1.70%、1.70%、0.85%、0.85%。革兰阳性菌主要为金黄色葡萄球菌(37株,15.74%)和表皮葡萄球菌(16株,6.81%),肺炎链球菌、粪肠球菌、无乳链球菌分别占比5.53%、2.98%、1.28%。真菌中主要为白色假丝酵母(13株,5.53%)和热带假丝酵母菌(3株,1.28%)。革兰阴性菌对庆大霉素、复方新诺明的耐药率高于50%,对头孢哌酮、头孢吡肟、头孢哌酮-舒巴坦、美罗培南、亚胺培南、阿米卡星的耐药率低于30%。革兰阳性菌对青霉素、红霉素、复方新诺明的耐药率高于50%,对环丙沙星、利福平的耐药率低于30%,未产生对万古霉素、利奈唑胺、替考拉宁的耐药株。真菌对氟康唑、伊曲康唑的耐药率较低,未产生对氟胞嘧啶的耐药株。肺部感染组患者血清IL-23、IL-17水平高于对照组患者(t=8.097,P<0.05)。血清IL-23、IL-17水平预测急性脑血管疾病合并肺Objective The distribution characteristics,drug resistance of pathogenic bacteria,and the predictive value of serum IL-17,IL-23 levels in patients with acute cerebrovascular disease complicated with pulmonary infection were explored for clinical treatment planning and early diagnosis.Methods 235 patients with acute cerebrovascular disease complicated with pulmonary infection and 8o patients with acute cerebrovascular disease without pulmonary infection who were admitted to our hospital were selected as the study subjects.The sputum samples were collected from patients to conduct bacterial identification and drug sensitivity tests.The levels of serum IL-23 and IL-17 of patients were determined.The predictive value of serum IL-23 and IL-17 levels for acute cerebrovascular diseases complicated with pulmonary infection was analyzed by the receiver operating characteristic curve.Results Among 235 patients with acute cerebrovascular disease complicated by pulmonary infection,46.81%were diagnosed with acute stroke(110/235),41.70%with acute cerebral hemorrhage(98/235),and 11.49%with other acute cerebrovascular diseases(27/235).A total of 235 strains of pathogenic bacteria were detected,including 143 strains of Gram-negative bacteria(60.85%),76 strains of Gram-positive bacteria(32.34%),and 16 strains of fungi(6.81%).Gram negative bacteria mainly consisted of Klebsiella pneumoniae(48 strains,20.43%)and Escherichia coli(40 strains,17.02%),Pseudomonas aeruginosa,Acinetobacter baumanni,Stenotrophomonas maltophilia,Haemophilus influenzae,Enterobacter cloacae,Proteus mirabilis,Enterobacter aerogenes,and Klebsiella acidogenes,accounting for 8.94%,4.68%,2.55%,2.13%,1.70%,1.70%,0.85%,and 0.85%,respectively.Gram positive bacteria were mainly Sta phylococcus aureus(37 strains,15.74%)and S.epidermidis(16 strains,6.81%),with S.pneumoniae,E.faecalis,and S.agalactiae accounting for 5.53%,2.98%,and 1.28%,respectively.The main fungi were Candida albicans(13 strains,5.53%)and C.tropicalis(3 strains,1.28%).The resistance rate of Gram negati

关 键 词：急性脑血管疾病 肺部感染 病原菌特征 白细胞介素-23 白细胞介素-17 

分 类 号：R743[医药卫生—神经病学与精神病学] R563[医药卫生—临床医学]