呼吸机相关性肺炎患者病原菌分布及其与Dectin-1/Syk信号通路的关联  

Distribution of pathogens in patients with ventilator-associated pneumonia and their association with Dectin-1/Syk signaling pathway

作　　者：郭会莉 林庆华[2] 朱瑞瑞[2] 齐连振 Guo Huili;Lin Qinghua;Zhu Ruirui;Qi Lianzhen(Department of Critical Care Medicine,Xingtai People's Hospital,Xingtai 054001,Hebei,China;Department of Critical Care Medicine,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China)

机构地区：[1]邢台市人民医院重症医学科,河北邢台054001 [2]邢台医学高等专科学校第二附属医院重症医学科,河北邢台054000

出　　处：《中华危重病急救医学》2025年第2期128-132,共5页Chinese Critical Care Medicine

基　　金：河北省邢台市重点研发计划项目(2022ZC183)。

摘　　要：目的分析呼吸机相关性肺炎(VAP)患者的病原菌分布及其与β-葡聚糖受体1抗体(Dectin-1)/脾酪氨酸激酶(Syk)信号通路的关联,为制定更有效的治疗策略和预防措施提供科学依据。方法采用前瞻性研究方法,纳入2021年1月至2023年3月邢台市人民医院重症医学科收治的160例VAP患者。采集患者呼吸道分泌物进行假丝酵母菌定植分析,然后利用全自动微生物鉴定仪对呼吸道分泌物的细菌进行鉴定;采用荧光免疫聚合酶链反应检测外周血单个核细胞中Dectin-1、Syk的表达水平;综合影像学、临床、微生物学标准进行临床肺部感染评分(CPIS)。比较是否定植假丝酵母菌两组患者的基础资料、病原菌分布、Dectin-1和Syk的表达水平以及CPIS评分。采用Spearman检验分析Dectin-1、Syk表达水平与VAP患者呼吸道假丝酵母菌定植和CPIS评分的相关性。结果160例VAP患者中有97例假丝酵母菌定植(定植组),63例无假丝酵母菌定植(无定植组)。定植组与无定植组性别(男性:57.73%比41.27%,P=0.042)、年龄(岁:57.98±12.46比62.09±10.61,P=0.029)比较差异存在统计学意义,但两组间机械通气时间、基础疾病及原发病比较差异无统计学意义。病原菌分布显示,定植组金黄色葡萄球菌感染率显著高于无定植组(24.74%比7.94%,P<0.05),两组其他革兰阳性菌和革兰阴性菌感染率比较差异均无统计学意义。定植组患者CPIS评分明显高于无定植组(分:8.73±0.43比7.31±0.39,P<0.01),外周血单个核细胞中Dectin-1、Syk表达水平明显高于无定植组(Dectin-1/U6:0.86±0.22比0.47±0.16,Syk/U6:0.77±0.18比0.42±0.11,均P<0.01)。VAP患者外周血单个核细胞中Dectin-1、Syk表达水平与呼吸道假丝酵母菌定植均呈显著正相关关系(r值分别为0.754、0.631,均P<0.05),与CPIS评分均呈显著正相关关系(r值分别为0.594、0.618,均P<0.05)。结论呼吸道假丝酵母菌定植VAP患者金黄色葡萄球菌占比较高,且DeObjective To analyze the pathogens distribution in patients with ventilator-associated pneumonia(VAP),and their association with anti-β-glucan receptor-1(Dectin-1)/spleen tyrosine kinase(Syk)signaling pathway,and to provide scientific basis for formulating more effective treatment strategies and preventive measures.Methods A prospective study was conducted.160 patients with VAP admitted to the department of critical care medicine of Xingtai People's Hospital from January 2021 to March 2023 were enrolled.The respiratory secretions of patients were collected for Candida colonization analysis,and then the bacteria in the respiratory secretions were identified by automatic microbial identification instrument.The expression levels of Dectin-1 and Syk in peripheral blood mononuclear cells were detected by fluorescent immunopolymerase chain reaction.Clinical pulmonary infection score(CPIS)was performed based on imaging,clinical and microbiological criteria.The basic data,pathogen distribution,Dectin-1 and Syk expression levels and CPIS score of the two groups were compared.Spearman test was used to analyze the correlation between the expression levels of Dectin-1 and Syk and respiratory Candida colonization and CPIS score.Results 160 VAP patients,97 were Candida colonized(colonized group)and 63 were not(non-colonized group).There were significantly differences in gender(males:57.73%vs.41.27%,P=0.042)and age(years:57.98±12.46 vs.62.09±10.61,P=0.029)between the colonized group and the non-colonized group,while there were no significantly differences in the data of duration of mechanical ventilation,underlying diseases and primary diseases.The distribution of pathogenic bacteria showed that the infection rate of Staphylococcus aureus in the colonized group was significantly higher than that in the non-colonized group(24.74%vs.7.94%,P<0.05),and there was no significantly difference in the infection rate of other G-positive and G-negative bacteria between the two groups.The CPIS score in the colonized group was significan

关 键 词：呼吸机相关性肺炎 病原菌分布 Dectin-1/Syk信号通路 相关性 

分 类 号：R563.1[医药卫生—呼吸系统]