机械通气患者口腔微生物多样性及其与呼吸机相关性肺炎的关联  

Oral microbial diversity and its association with ventilator-associated pneumonia in patients with mechanical ventilation

作　　者：唐兰 邹德庆[2] 陈文婷 李育林 贺玲[1] 黎维芳[3] 徐艳[1] 彭虹[3] 牟霞[1] TANG Lan;ZHOU De-qing;CHEN Wen-ting;LI Yu-lin;HE Ling;LI Wei-fang;XU Yan;PENG Hong;MOU Xia(Guizhou Provincial People's Hospital,Guiyang,Guihzou 550000,China)

机构地区：[1]贵州省人民医院医院感染管理科,贵州贵阳550000 [2]贵州省人民医院医院重症医学科,贵州贵阳550000 [3]贵州省人民医院医院感染科,贵州贵阳550000

出　　处：《中华医院感染学杂志》2024年第19期2913-2918,共6页Chinese Journal of Nosocomiology

基　　金：贵州省人民医院博士基金资助项目(GZSYBS[2016]10号);贵阳市科技计划基金资助项目(筑科合同[2022]-4-1-5号)。

摘　　要：目的分析机械通气患者口腔生物多样性及其与呼吸机相关性肺炎(VAP)的关联。方法选择2022年10月-2023年10月贵州省人民医院收治的机械通气患者为研究对象,分为非下呼吸道感染组(对照组)、社区获得性肺炎(CAP)组与VAP组,各6例。于患者口腔护理前行口咽部标本采样,后进行16S核糖体RNA(16S rRNA)基因测序,分析其口腔微生物。结果物种分析结果显示,在门与属分类水平上,CAP与VAP患者口腔微生物群落优势物种的组成相似;Chao1与Shannon指数显示对照组口腔微生物多样性与丰富度均高于CAP与VAP组患者(P<0.05);对照组、CAP组与VAP组患者组间样本分布差异有统计学意义,CAP患者中丰富度较高且有差异的是链球菌属、金氏菌属、埃希氏杆菌属与不动杆菌属;VAP患者中丰富度较高且有差异的是棒状杆菌属、大芬戈尔德菌属与斯内氏属(P<0.05);CAP与VAP患者痰培养出鲍氏不动杆菌与溶血不动杆菌等致病菌。结论机械通气肺炎患者口腔微生物群落多样性与丰富度降低,其中鲍氏不动杆菌与溶血不动杆菌感染可能与口腔中不动杆菌属丰富度高有关,口腔微生物组成模式分析可能利于VAP预测。OBJECTIVE To analyze the oral microbial diversity and its association with ventilator-associated pneumonia(VAP)in mechanically ventilated patients.METHODS Mechanically ventilated patients admitted to Guizhou Provincial People's Hospital from Oct.2022 to Oct.2023 were selected as the study subjects,and were divided into the non-lower respiratory infection group(Control group),the community-acquired pneumonia(CAP)group and ventilator-associated pneumonia(VAP)group,with 6 cases in each group.Oral pharyngeal specimens were sampled before oral care,followed by 16S rRNA gene sequencing to analyze their oral microorganisms.RESULTS The results of species analysis showed that the composition of dominant species of oral microbial communities was similar in CAP and VAP patients at the phylum and genus classification level.Chaol and Shannon indices showed that the diversity and abundance of oral microorganisms in control were higher than those in CAP and VAP patients(P<0.05).There were differences in sample distribution among the control,CAP and VAP groups,with Streptococcus,Kingella,Escherichia and Acinetobacter being more abundant and varied in CAP patients,Corynebacterium,Fingoldelia and Snape being more abundant and different in VAP patients(P<o.05),and Fusobacterium bovis and Fusobacterium haemolyticum being causive organisms in sputum cultures of CAP and VAP patients.CONCLUSION The diversity and abundance of oral microbial communities were reduced in patients with mechanical ventilation-related pneumonia,in which Acinetobacter baumannii and Acinetobacter hemolyticus infections may be associated with a high abundance of Acinetobacter in the mouth,and the analysis of oral microbial compositional pattern may be beneficial for VAP prediction.

关 键 词：机械通气 16S核糖体RNA 生物多样性分析 口腔菌群 呼吸机相关性肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]