老年重症肺炎患者肠道菌群与炎症介质、病情程度及预后的关联研究  

Relationship between intestinal flora and inflammatory mediators,disease degree and prognosis in elderly patients with severe pneumonia

作　　者：范建 张楠 吴瑞 田茂良 Fan Jian;Zhang Nan;Wu Rui;Tian Maoiang(Department of Respiratory and Critical Care Medicine,Zigong First People’s Hospital,Zigong Sichuan 643000,China)

机构地区：[1]四川省自贡市第一人民医院呼吸与危重症医学科,四川自贡643000

出　　处：《中国医刊》2025年第3期278-282,共5页Chinese Journal of Medicine

基　　金：四川省医学科研项目(S19046)。

摘　　要：目的探讨老年重症肺炎(severe pneumonia,SP)患者肠道菌群与炎症介质、病情程度及预后的关系。方法选取2021年4月至2024年3月四川省自贡市第一人民医院收治的108例老年SP患者,以痊愈出院为随访终点,根据生存情况分为死亡组(27例)和生存组(81例)。比较两组患者的肠道菌群分布(屎肠球菌、粪肠球菌、双歧杆菌、乳酸杆菌),血清降钙素原(PCT)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)水平及肺炎严重程度(PSI)评分。采用Pearson相关分析探讨肠道菌群与PSI评分、炎症介质的相关性,采用logistic回归分析探讨老年SP患者死亡的危险因素。结果死亡组患者肠道屎肠球菌、粪肠球菌数量,血清PCT、IL-6、TNF-α水平及PSI评分均高于生存组(P<0.05),肠道双歧杆菌、乳酸杆菌数量低于生存组(P<0.05)。Pearson相关性分析显示,老年SP患者肠道屎肠球菌、粪肠球菌数量与血清PCT、IL-6、TNF-α水平及PSI评分均呈正相关(P<0.05),而肠道双歧杆菌、乳酸杆菌数量与血清PCT、IL-6、TNF-α水平及PSI评分均呈负相关(P<0.05)。死亡组患者的年龄、急性肾衰竭比例、低蛋白血症比例、餐后2 h平躺比例、急性生理学与慢性健康状况评价Ⅱ评分及谷丙转氨酶、血肌酐、尿素氮水平均高于生存组,而氧合指数低于生存组(P<0.05)。多因素logistic回归分析显示,粪肠球菌数量增多、PSI评分增高是老年SP患者死亡的独立危险因素,双歧杆菌数量增多则是其保护因素(P<0.05)。结论老年SP患者存在肠道菌群紊乱,血清炎症介质水平偏高,肠道菌群与患者预后密切相关,粪肠球菌数量增多,双歧杆菌数量降低,老年SP患者死亡风险增大。Objective To investigate the relationship between intestinal flora and inflammatory mediators,disease degree and prognosis in elderly patients with severe pneumonia(SP).Method 108 elderly SP patients admitted to Zigong First People’s Hospital were enrolled from April 2021 to March 2024.The survival of the patients was recorded,with recovery and discharge as the end point of follow-up.According to the survival situation,the patients were divided into death group and survival group.Intestinal flora(Enterococcus faecium,Enterococcus faecalis,Bifidobacterium,Lactobacillus),inflammatory mediators[interleukin-6(IL-6),tumor necrosis factorα(TNF-α)]and pneumonia severity(PSI)scores were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between intestinal flora,PSI score and inflammatory mediators,and the risk factors of death in elderly SP patients were analyzed by logistic regression analysis.Result The levels of enterococcus faecium,Enterococcus faecalis,inflammatory mediators and PSI scores of the two groups were higher in the death group(P<0.05),while the levels of bifidobacterium and lactobacillus were lower(P<0.05).Pearson correlation analysis showed that enterococcus faecium and enterococcus faecalis in the intestines of elderly SP patients were positively correlated with PCT,IL-6,TNF-αand PSI scores(renterococcus faecium=0.589,0.612,0.462,0.527,r_(enterococcus faecalis)=0.475,0.493,0.610,0.504,P<0.05),while bifidobacterium and lactobacillus were negatively correlated with the above indexes(r_(bifidobacterium)=-0.550,-0.572,-0.463,-0.642,r_(lactobacillus)=-0.486,-0.517,-0.533,-0.605,P<0.05).Age,proportion of acute renal failure,proportion of hypoproteinemia,proportion of lying flat 2 h after meals,acute physiological and chronic health score(APACHEⅡ)and levels of alanine aminotransferase(ALT),blood creatinine(Scr)and urea nitrogen(BUN)in death group were higher than those in survival group,but oxygenation index was lower than those in survival group(P<0.05).L

关 键 词：重症肺炎 肠道菌群 炎症介质 预后 

分 类 号：R563.1[医药卫生—呼吸系统]