脓毒症病原菌和耐药性及血清miRNA对其预后评估价值  

Distribution and drug resistance of pathogens isolated from sepsis patients and value of serum miRNA in assessment of prognosis

作　　者：吴晓莉[1] 徐美红[2] 黄蓉[1] 刘春[2] WU Xiao-li;XU Mei-hong;HUANG Rong;LIU Chun(Nantong University Affiliated Hospital,Nantong City,Jiangsu Province,Nantong,Jiangsu 226001,China)

机构地区：[1]江苏省南通市南通大学附属医院急诊医学科重症监护室,江苏南通226001 [2]江苏省南通市南通大学附属医院急诊医学科,江苏南通226001

出　　处：《中华医院感染学杂志》2024年第21期3231-3235,共5页Chinese Journal of Nosocomiology

基　　金：江苏省自然科学基金资助项目(BK20221376)。

摘　　要：目的探讨脓毒症病原菌和耐药性及血清微小核糖核酸(miR)对其预后评估价值。方法选择2020年7月-2023年7月江苏省南通市南通大学附属医院急诊医学重症监护室收治的99例脓毒症患者为研究对象,根据随访28 d结果分为生存组74例和死亡组25例。检测脓毒症感染病原菌分布及耐药性;实时荧光定量聚合酶链式反应检测血清miR-122、miR-181b、miR-10a、miR-155水平;受试者工作特征(ROC)曲线分析四指标对脓毒症患者预后评估价值。结果脓毒症患者分离出103株病原菌,革兰阴性菌多。构成比高的是大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌。大肠埃希菌对头孢唑林和氨苄西林耐药性强,亚胺培南和阿米卡星敏感;肺炎克雷伯菌对头孢唑林和头孢曲松耐药性强,头孢哌酮敏感;金黄色葡萄球菌对万古霉素敏感,青霉素和红霉素耐药性强。死亡组血清miR-122、miR-10a、miR-155水平比生存组高(P<0.05),miR-181b水平低于生存组(P<0.05)。绘制ROC曲线获得四指标联合诊断脓毒症患者预后曲线下面积(AUC)高于单独检测(P<0.05),敏感度和特异度为88.00%和90.50%。结论脓毒症患者感染多是革兰阴性菌,各病原菌耐药性有差异,对常用抗菌药物有较高耐药性。miR-122、miR-181b、miR-10a、miR-155参与脓毒症患者预后不良的发生,联合检测有助于诊断脓毒症预后。OBJECTIVE To explore the distribution and drug resistance of the pathogens isolated from the sepsis patients and analyze the value of serum micro ribonucleic acids(miR)in assessment of prognosis.METHODS A total of 99 patients with sepsis who were treated in emergency medicine intensive care unit of Nantong University Affiliated Hospital from Jul.2020 to Jul.2023 were recruited as the research subjects and were divided into the survival group with 74 cases and the death group with 25 cases according to the result of 28-day follow-up.The distribution and drug resistance of the pathogens isolated from the sepsis patients were observed.The levels of serum miR-122,miR-181b,miR-10a and miR-155 were detected by using real-time florescent quantitative polymerase chain reaction.The values of the four indexes in assessment of the prognosis were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 103 strains of pathogens were isolated from the sepsis patients,among which gram-negative bacteria wee dominant;Escherichia coli,Klebsiella pneumoniae and Staphylococcus aureus were the predominant species of the pathogens.The E.coli strains were highly resistant to cefazolin and ampicillin,while the strains were sensitive to imipenem and amikacin.The K.pneumoniae strains were highly resistant to cefazolin and ceftriaxone,while the strains were sensitive to cefoperazone.The S.aureus strains were sensitive to vancomycin,while the strains were highly resistant to penicillin and erythromycin.The levels of serum miR-122,miR-10a and miR-155 of the death group were higher than those of the survival group(P<0.05),while the miR-181b level of the death group was lower than that of the survival group(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the joint detection of the four indexes was higher than that of the single detection in assessment of the prognosis of the sepsis patients(P<0.05),with the sensitivity 88.00%,the specificity 90.50%.CONCLUSIONS The gram-negative bacteria are domin

关 键 词：脓毒症 病原菌 耐药性 微小核糖核酸-122 微小核糖核酸-181b 微小核糖核酸-10a 微小核糖核酸-155 评估价值 受试者工作特征曲线 

分 类 号：R631[医药卫生—外科学]