摘要
目的探讨重症肺炎患者感染病原学特点,分析患者血清胆碱酯酶(ChE)、晚期糖化产物受体(RAGE)水平与病情进展的关系。方法选取2020年1月-2021年1月在我院就诊的82例重症肺炎患者作为重症肺炎组,90例普通肺炎患者作为普通肺炎组,以及同期在医院进行体检的90例健康体检者作为对照组,并根据急性生理和慢性健康Ⅱ(APACHEⅡ)评分将重症肺炎患者分为轻度组(n=32)、中度组(n=27)、重度组(n=23)。采集重症肺炎组患者的气道深部痰液标本进行病原菌检查,同时采集各组受检者的血液标本,检测并比较血清ChE、RAGE水平,分析其与患者病情进展之间的相关性。结果重症肺炎组患者感染革兰阴性菌84株(64.12%),革兰阳性菌34株(25.95%),前者以肺炎链球菌、金黄色葡萄球菌为主,后者以肺炎克雷伯菌、大肠埃希菌为主。重症肺炎组、普通肺炎组、对照组血气分析指标氧分压(PaO;)、二氧化碳分压(PaCO;)和肺功能指标第1秒最大呼气容积(FEV1)、用力肺活量(FVC)、最高呼气流速(PEF)比较差异有统计学意义(P<0.05),重症肺炎患者重度组、中度组和轻度组血气分析指标和肺功能指标比较差异有统计学意义(P<0.05)。重症肺炎组、普通肺炎组和对照组的血清ChE、RAGE比较差异有统计学意义(P<0.05),其中重症肺炎组的血清ChE显著低于普通肺炎组和对照组,RAGE显著高于普通肺炎组和对照组(P<0.05),普通肺炎组的血清ChE也明显低于对照组,RAGE明显高于对照组(P<0.05);重症肺炎患者重度组、中度组和轻度组血清ChE、RAGE比较差异有统计学意义(P<0.05),其中重症组的血清ChE明显低于中度组和轻度组,RAGE明显高于中度组和轻度组(P<0.05),中度组的血清ChE明显高于轻度组,RAGE明显高于轻度组(P<0.05)。相关性分析显示,重症肺炎患者的血清ChE水平与APACHEⅡ评分呈明显负相关(r=-0.493,P=0.000),RAGE水平与APACHEⅡ评分呈明显正相关(r=0.472,P=0.000)。结论革兰阴性菌为重症肺炎患者的主要致病菌,随着病情的发展,患者血气分析和肺功能指标逐渐恶化,同时血清ChE水平下降,RAGE水平升高,血清ChE和RAGE水平与重症肺炎患者病情进展有关,可通过二者来判断患者病情严重程度。
Objective To investigate the etiological characteristics of patients with severe pneumonia and to analyze the relationship between the levels of serum cholinesterase(CHE)and advanced glycation product receptor(RAGE)and disease progression.Methods Eighty-two patients with severe pneumonia seen at this Hospital from January 2020 to January 2021 served as patients with severe pneumonia,90 patients with typical pneumonia served as patients with typical pneumonia,and 90 healthy people who underwent a physical examination at this Hospital during the same period served as the control group.Based on their Acute Physiology and Chronic Health Evaluation II(APACHE II)scores,patients with severe pneumonia were divided into those with slightly severe pneumonia(n=32),those with moderately severe pneumonia(n=27),and those with highly severe pneumonia(n=23).Deep airway sputum samples from patients with severe pneumonia were collected for pathogen examination.Blood samples were collected from all subjects to determine and compare serum ChE and RAGE levels,and the correlation between those levels and disease progression was analyzed.Results In patients with severe pneumonia,84 strains of Gram-negative bacteria(64.12%)and 34 strains of Gram-positive bacteria(25.95%)were detected.Gram-negative bacteria were mainly Streptococcus pneumoniae and Staphylococcus aureus,and Gram-positive bacteria were mainly Klebsiella pneumoniae and Escherichia coli.There were significant differences in blood gas analysis indicators including partial pressure of oxygen(PaO2)and partial pressure of carbon dioxide(PaCO2),and lung function indicators including forced expiratory volume in one second(FEV1),forced vital capacity(FVC),and maximum expiratory flow(PEF)among patients with severe pneumonia,patients with typical pneumonia,and the control group(P<0.05),and there were also significant differences in those indices among patients with highly severe pneumonia,patients with moderately severe pneumonia,and patients with slightly severe pneumonia(P<0.05).There were significant differences in serum ChE and RAGE among patients with severe pneumonia,patients with typical pneumonia,and the control group(P<0.05).Serum ChE in patients with severe pneumonia was significantly lower than that in patients with typical pneumonia and the control group,and RAGE was significantly higher than that in patients with typical pneumonia and the control group(P<0.05).Serum ChE in patients with typical pneumonia was also significantly lower than that in the control group,and RAGE was significantly higher than that in the control group(P<0.05).Serum ChE and RAGE differed significantly in patients with highly severe pneumonia,patients with moderately severe pneumonia,and patients with slightly severe pneumonia(P<0.05).Serum ChE in patients with highly severe pneumonia was significantly lower than that in patients with moderately severe pneumonia and patients with slightly severe pneumonia,and RAGE was significantly higher than that in patients with moderately severe pneumonia and patients with slightly severe pneumonia(P<0.05).Serum ChE in patients with moderately severe pneumonia was significantly higher than that in patients with slightly severe pneumonia,and RAGE was significantly higher than that in patients with slightly severe pneumonia(P<0.05).Correlation analysis indicated that the serum ChE level in patients with severe pneumonia was negatively correlated with the ApacheⅡscore(r=-0.493,P=0.000),and the RAGE level was positively correlated with the ApacheⅡscore(r=0.472,P=0.000).Conclusion Gram-negative bacteria are the main pathogenic bacteria found in patients with severe pneumonia.As the disease develops,the blood gas analysis and lung function indices of patients gradually worsen.At the same time,the serum ChE level decreases and the RAGE level increases.In patients with severe pneumonia,the serum ChE and RAGE levels are related to the progression of the disease,and the severity of the disease can be determined based on the levels of those two indicators.
作者
邱少聪
未先洁
徐江荣
QIU Shao-cong;WEI Xian-jie;XU Jiang-rong(The First People’s Hospital of Jingdezhen,Jingdezhen 333000,Jiangxi China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2021年第12期1465-1469,1473,共6页
Journal of Pathogen Biology
关键词
重症肺炎
病原学特点
病情进展
胆碱酯酶
晚期糖化产物受体
severe pneumonia
etiological characteristics
progress of the disease
cholinesterase
receptor for advanced glycation products
作者简介
通讯作者:邱少聪(1970-),男,江西人,本科,副主任医师,主要从事重症肺炎相关研究。E-mail:13879888535@163.com。
