肺炎克雷伯菌毒力基因检测及peg-344的诊断效能研究  

Detection of virulence genes of Klebsiella pneumoniae and diagnostic efficacy of peg-344

作　　者：杨文硕 居乐阳 陈典典 王岩[1] 王培昌[1] 曹敬荣[1] YANG Wenshuo;JU Leyang;CHEN Diandian;WANG Yan;WANG Peichang;CAO Jingrong(Department of Clinical Laboratory,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Clinical Laboratory Diagnosis,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学宣武医院检验科,北京100053 [2]首都医科大学临床检验诊断学系,北京100070

出　　处：《国际检验医学杂志》2025年第7期769-772,779,共5页International Journal of Laboratory Medicine

基　　金：高层次公共卫生技术人才建设项目(学科骨干-01-023)。

摘　　要：目的探讨临床分离的肺炎克雷伯菌(KPN)毒力基因分布及peg-344对高毒力菌株的诊断效能。方法收集2023年1-12月首都医科大学宣武医院分离的KPN菌株,采用Whonet5.6分析菌株分布及耐药情况,毒力检测包括拉丝试验、PCR扩增毒力基因(peg-344、rmpA、iutA、iroB)和K1、K2荚膜血清型、血清抗性试验,采用受试者工作特征曲线分析诊断效能。结果收集的122株KPN菌株中敏感菌45株(36.9%)、超广谱β-内酰胺酶阳性菌20株(16.4%)、碳青霉烯耐药菌57株(46.7%);标本主要分离自痰液、尿液和血液,主要来源于泌尿外科、神经内科、重症监护室和神经外科;拉丝试验阳性率27.9%,PCR检出毒力基因K1(12.3%)、K2(8.2%)、peg-344(62.3%)、rmpA(60.7%)和iutA(73.8%),iroB阴性,同时检出多种毒力基因菌占63.1%;血清抗性试验1~2级、3~4级和5~6级菌株分别占43.5%、31.1%和25.4%;peg-344诊断高毒力菌株的曲线下面积最大,其次为peg-344+iutA和peg-344+rmpA。结论该院KPN分布广泛,存在多种毒力基因,peg-344对区分低毒力株和高毒力株有一定临床价值。Objective To investigate the distribution of virulence genes of Klebsiella pneumoniae(KPN)and to evaluate the diagnostic efficacy of peg-344 for hypervirulent strains.Methods KPN isolates were collected from January to December in 2023 in Xuanwu Hospital,Capital Medical University.Whonet5.6 was used to analyze the distribution and drug resistance of bacterial strains.Toxicity testing included wire string test,PCR amplification of virulence genes(peg-344,rmpA,iutA,iroB),K1 and K2 capsule serotypes,serum resistance test,and diagnostic efficacy of detection was analyzed by using receiver operating characteristic curve.Results A total of 122 KPN isolates were collected,including 45(36.9%)sensitive strains,20(16.4%)extended-spectrumβ-lactamase positive strains,and 57(46.7%)carbapenem-resistant Klebsiella pneumoniae strains.The specimens were mainly isolated from sputum,urine,and blood,and mainly came from Department of Urology,Department of Neurology,Intensive Care Unit,and Department of Neurosurgery.The positive rate of string test was 27.9%.PCR detected K1(12.3%),K2(8.2%),peg-344(62.3%),rmpA(60.7%),and iutA(73.8%),but the iroB result was negative,and strains with multiple virulence genes accounted for 63.1%.The results of the serum resistance test showed that 43.5%,31.1%,and 25.4%of the samples were at levels 1-2,3-4,and 5-6,respectively.peg-344 had the largest area under the curve for diagnosing the hypervirulent strains,followed by peg-344+iutA and peg-344+rmpA.Conclusion KPN is widely distributed in the hospital,and there are a variety of virulence genes.peg-344 has clinical value in distinguishing low virulence from high virulence in KPN.

关 键 词：高毒力肺炎克雷伯菌 毒力基因 peg-344 诊断效能 

分 类 号：R446.5[医药卫生—诊断学]