摘要
目的探讨呼吸机相关性肺炎(VAP)革兰阴性菌感染及NOD样受体蛋白3(NLRP3)炎症体通路的预测价值.方法选取2019年1月-2022年12月120例宣城人民医院接受机械通气治疗后确诊VAP革兰阴性菌感染患者为感染组,另随机选取同期于医院接受机械通气治疗后排除VAP的120例患者为非感染组.分析感染组革兰阴性菌情况,比较两组临床特征及外周血NLRP3 mRNA、半胱氨酸天冬氨酸蛋白酶(Caspase)-1 mRNA与白细胞介素(IL)-1β、IL-8水平;比较不同病情严重程度患者外周血NLRP3 mRNA、Caspase-1 mRNA与IL-1β、IL-8水平;受试者工作特征(ROC)曲线分析NLRP3炎症体通路指标的评估价值.结果120例VAP革兰阴性菌感染患者共分离革兰阴性菌137株,以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌和大肠埃希菌为主.感染组患者外周血NLRP3 mRNA、Caspase-1 mRNA、IL-1β、IL-8水平高于非感染组(P<0.05).感染组中低危患者外周血NLRP3 mRNA、Caspase-1 mRNA与IL-1β、IL-8水平低于高危患者(P<0.05).ROC曲线分析,外周血NLRP3 mRNA、Caspase-1 mRNA与IL-1β、IL-8水平评估患者病情严重程度的曲线下面积(AUC)分别为0.839、0.823,0.804和0.802(P<0.05).结论VAP革兰阴性菌感染病原菌以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌和大肠埃希菌为主,NLRP3炎症体通路蛋白和相关炎症因子对疾病严重程度具有较高的预测价值.
OBJECTIVE To explore the gram-negative bacteria causing ventilator-associated pneumonia(VAP)and analyze the predictive values of NOD-like receptor protein 3(NLRP3)inflammasome pathways.METHODS From Jan 2019 to Dec 2022,a total of 120 patients who were diagnosed with gram-negative bacteria VAP in Xuancheng Peoples Hospital after mechanical ventilation were assigned as the infection group,meanwhile,120 patients who did not have VAP after the mechanical ventilation were chosen as the non-infection group.The distribution of the gram-negative bacteria was analyzed.The clinical characteristics and levels of peripheral blood NLRP3 mRNA,cysteinyl aspartate specificproteinase-1(Caspase-1)mRNA,interleukin(IL)-1βand IL-8 were compared between the two groups;the levels of peripheral blood NLRP3 mRNA,Caspase-1 mRNA,IL-1βand IL-8 were compared among the patients with different severities of diseases.The predictive values of NLRP3 inflammasome pathways were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 137 strains of gram-negative bacteria were isolated from the 120 patients with gram-negative bacteria VAP;Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii and Escherichia coli were the predominant species.The levels of peripheral blood NLRP3 mRNA,Caspase-1 mRNA,IL-1βand IL-8 of the infection group were significantly higher than those of the non-infection group(P<0.05).In the infection group,the levels of peripheral blood NLRP3 mRNA,Caspase-1 mRNA,IL-1βand IL-8 of the moderate and low risk patients were significantly lower than those of the high risk patients(P<0.05).ROC curve analysis showed that the areas under curves(AUCs)of the peripheral blood NLRP3 mRNA,Caspase-1 mRNA,IL-1βand IL-8 were respectively 0.839,0.823,0.804 and 0.802 in assessment of the severity of disease(P<0.05).CONCLUSION P.aeruginosa,K.pneumoniae,A.baumanni and E.coli are dominant among the gram-negative bacteria causing VAP.The NLRP3 inflammasome pathways and related inflammatory factors have high values in prediction of severity of diseases.
作者
葛冰磊
陈永红
张青松
江奇峰
GE Bing-lei;CHEN Yong-hong;ZHANG Qing-song;JIANG Qi-feng(Xuancheng People's Hospital,Xuancheng,Anhui 242000,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第21期3225-3229,共5页
Chinese Journal of Nosocomiology
基金
安徽省自然科学基金资助项目(1808085MH293)。
关键词
呼吸机相关性肺炎
革兰阴性菌
NOD样受体蛋白3
炎症体通路
Ventilator-associated pneumonia
Gram-negative bacteria
NOD-like receptor protein 3
Inflammasome pathway
作者简介
葛冰磊(1969-),女,本科,主任技师,研究方向:临床微生物及分子生物学。
