呼吸机相关性肺炎患者免疫功能、NE和PCT的检测及相关危险因素分析
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摘要
目的探讨呼吸机相关性肺炎(VAP)患者病原学分布、免疫功能及NE和PCT的水平,并分析其感染相关危险因素。方法无锡市第三人民医院2016年3月-2017年3月呼吸内科收治的VAP患者100例,采用培养法检测痰液中的细菌,分析病原菌感染情况;采用流式细胞术法检测患者外周血及支气管肺泡灌洗液(BALF)中CD4~+CD25~+CD127~+dim/~- Tregs百分比,采用ELASA法检测外周血及BALF中IL-35、NE和PCT水平;采用多因素Logistic回归法分析VAP发生危险因素。实验设健康人对照及单侧肺部感染患者未感染侧对照。结果 100例VAP患者的痰液标本中共分离培养出细菌127株,其中革兰阴性菌占69.29%,革兰阳性菌占30.71%;血IL-35及CD4~+CD25~+CD127~+dim/~- Tregs百分比分别为(32.11±0.30) pg/ml和(7.83±0.07)%,与对照组(30.45±0.31) pg/ml和(6.97±0.07)%比较差异均无统计学意义(t=1.594,1.654,P>0.05); 20例单侧肺部感染患者感染侧BALF中IL-35及CD4~+CD25~+CD127~+dim/-Tregs百分比分别为(38.46±0.39) pg/ml和(10.56±0.11)%,非感染侧分别为(21.74±0.22)和(7.04±0.71)%,差异均有统计学意义(t=281.296,184.752,P<0.05)。血NE和PCT VAP组分别为(160.57±16.74)μg/ml和(4.56±0.47) ng/ml,对照组分别为(74.58±7.46)和(0.39±0.04),差异均有统计学意义(t=34.601,62.519,P<0.05);单侧肺部感染患者感染侧BALF中NE及PCT分别为(162.38±16.37)μg/ml和(9.16±0.95)μg/ml,非感染侧分别为(95.03±9.61)μg/ml和(0.47±0.05)μg/ml,差异均有统计学意义(t=26.843,64.528,P<0.05)。多因素Logistic回归法分析机械通气时间>5 d、年龄≥65岁、APACHEⅡ评分>18分和慢性阻塞性肺疾病既往史均是VAP感染发生的独立危险因素。结论 VAP患者BALF中CD4~+CD25~+CD127~+dim/~- Tregs细胞百分比及IL-35、NE和PCT水平显著升高,机械通气时间长(>5 d)、高龄(≥65岁)、APACHEⅡ评分高(>18分)、有慢性阻塞性肺疾病既往史等为VAP感染发生危险因素,可为该病的防治提供参考。
Objective To investigate the pathogenic distribution, immune function, and NE and PCT levels in patients with ventilator-associated pneumonia(VAP) and to analyze related risk factors. Methods Subjects were 100 patients with VAP who were seen in Respiratory Medicine at the Third People's Hospital of the City of Wuxi from March 2016 to March 2017. Bacteria were detected in sputum via a bacterial culture, and the prevalence of a bacterial infection was analyzed. The percentage of CD4~+CD25~+CD127~+dim/~- Tregs in peripheral blood and bronchoalveolar lavage fluid(BALF) was determined using flow cytometry. The levels of IL-35, NE, and PCT in peripheral blood and BALF were determined using ELISA. The risk factors for VAP were analyzed using multivariate logistic regression analysis. This study also included healthy controls and the other(uninfected) lung of patients with an infection in one lung. Results A total of 127 strains of bacteria were isolated from 100 patients with VAP. Gram-negative bacteria accounted for 69.29% of the strains and Gram-positive bacteria accounted for 30.71%. The levels of blood IL-35 and CD4~+CD25~+CD127~+dim/~- Tregs in the VAP group were 32.11±0.30 pg/mL and 7.83±0.07%, respectively, while the levels of those indicators in the control group were 30.45±0.31 pg/mL and 6.97±0.07, respectively. There were no significant differences in those indicators(t=1.594, 1.654, P>0.05). The levels of IL-35 and CD4~+CD25~+CD127~+dim/~- Tregs in the BALF from the infected lung of 20 patients with an infection in one lung were 38.46±0.39 pg/mL and 10.56±0.11%, respectively, while the levels of those indicators in the BALF from the uninfected lung were 21.74±0.22 and 7.04±0.71%, respectively. Differences in those indicators were significant(t=281.296,184.752, P<0.05). The blood NE and PCT in the VAP group were 160.57±16.74 μg/mL and 4.56±0.47 ng/mL, respectively, while levels in the control group were 74.58±7.46 and 0.39±0.04, respectively. The difference was significant(t =34.601,62.519, P<0.05). NE and PCT in the BALF from the infected lung of patients with an infection in one lung were 162.38±16.37 μg/mL and 9.16±0.95 μg/mL, respectively, while levels in the uninfected lung were 95.03±9.61 μg/mL and 0.47±0.05 μg/mL, respectively. The difference was significant(t=26.843, 64.528, P<0.05). Multivariate logistic regression analysis indicated that time on mechanical ventilation >5 d, age≥65 years, an APACHEII score higher than 18 points, and a history of COPD were independent risk factors for VAP. Conclusion The percentage of CD4~+CD25~+CD127~+dim/~- Tregs cells and the levels of IL-35, NE, and PCT in BALF were significantly higher in patients with VAP. A long time on mechanical ventilation(>5 d), advanced age(≥65 years), a high APACHEII score(higher than 18 points), a history of COPD, and other risk factors can provide a reference for the prevention and treatment of VAP.
Objective To investigate the pathogenic distribution, immune function, and NE and PCT levels in patients with ventilator-associated pneumonia(VAP) and to analyze related risk factors. Methods Subjects were 100 patients with VAP who were seen in Respiratory Medicine at the Third People's Hospital of the City of Wuxi from March 2016 to March 2017. Bacteria were detected in sputum via a bacterial culture, and the prevalence of a bacterial infection was analyzed. The percentage of CD4~+CD25~+CD127~+dim/~- Tregs in peripheral blood and bronchoalveolar lavage fluid(BALF) was determined using flow cytometry. The levels of IL-35, NE, and PCT in peripheral blood and BALF were determined using ELISA. The risk factors for VAP were analyzed using multivariate logistic regression analysis. This study also included healthy controls and the other(uninfected) lung of patients with an infection in one lung. Results A total of 127 strains of bacteria were isolated from 100 patients with VAP. Gram-negative bacteria accounted for 69.29% of the strains and Gram-positive bacteria accounted for 30.71%. The levels of blood IL-35 and CD4~+CD25~+CD127~+dim/~- Tregs in the VAP group were 32.11±0.30 pg/mL and 7.83±0.07%, respectively, while the levels of those indicators in the control group were 30.45±0.31 pg/mL and 6.97±0.07, respectively. There were no significant differences in those indicators(t=1.594, 1.654, P>0.05). The levels of IL-35 and CD4~+CD25~+CD127~+dim/~- Tregs in the BALF from the infected lung of 20 patients with an infection in one lung were 38.46±0.39 pg/mL and 10.56±0.11%, respectively, while the levels of those indicators in the BALF from the uninfected lung were 21.74±0.22 and 7.04±0.71%, respectively. Differences in those indicators were significant(t=281.296,184.752, P<0.05). The blood NE and PCT in the VAP group were 160.57±16.74 μg/mL and 4.56±0.47 ng/mL, respectively, while levels in the control group were 74.58±7.46 and 0.39±0.04, respectively. The difference was significant(t =34.601,62.519, P<0.05). NE and PCT in the BALF from the infected lung of patients with an infection in one lung were 162.38±16.37 μg/mL and 9.16±0.95 μg/mL, respectively, while levels in the uninfected lung were 95.03±9.61 μg/mL and 0.47±0.05 μg/mL, respectively. The difference was significant(t=26.843, 64.528, P<0.05). Multivariate logistic regression analysis indicated that time on mechanical ventilation >5 d, age≥65 years, an APACHEII score higher than 18 points, and a history of COPD were independent risk factors for VAP. Conclusion The percentage of CD4~+CD25~+CD127~+dim/~- Tregs cells and the levels of IL-35, NE, and PCT in BALF were significantly higher in patients with VAP. A long time on mechanical ventilation(>5 d), advanced age(≥65 years), a high APACHEII score(higher than 18 points), a history of COPD, and other risk factors can provide a reference for the prevention and treatment of VAP.
引文
[1] 王龙梅,俞兴群.呼吸机相关性肺炎病原菌分布及危险因素分析[J].安徽医学,2017,38(3):301-3.
[2] Lawal O,Muhamadali H,Ahmed W,et al.Headspace volatile organic compounds from bacteria implicated in ventilator-associated pneumonia analysed by TD-GC/MS[J].J Breath Res,2017,12(2):026002.
[3] Guan SY,Leng RX,Khan MI,et al.Interleukin-35:a potential therapeutic agent for autoimmune diseases[J].Inflammation,2016,40(1):1-8.
[4] 李华,任冬冬,王振涛.降钙素原与临床肺部感染评分评估呼吸机相关性肺炎预后的研究[J].中华医院感染学杂志,2014,24(12):2901-3.
[5] Rea-Neto A,Youssef NC ,Tuche F,et al.Diagnosis of ventilator-associated pneumonia:a systematic review of the literature[J].Crit Care Med,2008,12(2):R56.
[6] 刁燕颜,罗萍,余江萍.重症监护病房呼吸机相关性肺炎的相关因素分析及预防[J].广东医学,2016,37(1):137-8,139.
[7] Zagli G,Cozzolino M,Terreni A,et al.Diagnosis of ventilator-associated pneumonia:a pilot,exploratory analysis of a new score based on procalcitonin and chest echography[J].Chest,2014,146(6):1578-85.
[8] 张英民,毛毅敏,孙瑜霞.纤维支气管镜辅助治疗重症呼吸机相关性肺炎的疗效观察[J].中国内镜杂志,2015,21(3):239-42.
[9] 申小侠,徐凤玲,洪静芳.ICU呼吸机相关性肺炎预防控制质量核查单的设计及应用[J].广东医学,2017,38(7):1126-30.
[10] 席红利,杨丽娜,李娟.呼吸机相关性肺炎患者病原菌检测的意义及其PCT、CRP、肺功能的变化研究[J].国际检验医学杂志,2018,39(13):1602-5,1609.
[11] 王红民,张小红,叶立群,等.白细胞介素-35调控CD4+CD25+CD127 dim/-调节性T细胞在呼吸机相关性肺炎发病中的作用[J].中华微生物学和免疫学杂志,2017,37(9):674-80.
[12] 马大文,刘峰.降钙素原监测在老年患者治疗呼吸机相关性肺炎中的作用[J].中国老年学杂志,2017,37(4):925-7.
[13] 梁添书,邬敏志,谭家余,等.中性粒细胞弹性蛋白酶对呼吸机相关性肺炎诊断及转归的评估价值[J].中华危重病急救医学,2016,28(9):785-9.
[14] 韦艳,李晓阳,丁丽丽,等.重症监护病房呼吸机相关性肺炎的危险因素分析[J].中国感染与化疗杂志,2014,14(1):7-10.
[15] 万自芬,余红,夏婧,等.呼吸危重症监护病房患者下呼吸道感染菌分布及多重耐药危险因素分析[J].中国临床医生,2014,42(2):33-5.
[2] Lawal O,Muhamadali H,Ahmed W,et al.Headspace volatile organic compounds from bacteria implicated in ventilator-associated pneumonia analysed by TD-GC/MS[J].J Breath Res,2017,12(2):026002.
[3] Guan SY,Leng RX,Khan MI,et al.Interleukin-35:a potential therapeutic agent for autoimmune diseases[J].Inflammation,2016,40(1):1-8.
[4] 李华,任冬冬,王振涛.降钙素原与临床肺部感染评分评估呼吸机相关性肺炎预后的研究[J].中华医院感染学杂志,2014,24(12):2901-3.
[5] Rea-Neto A,Youssef NC ,Tuche F,et al.Diagnosis of ventilator-associated pneumonia:a systematic review of the literature[J].Crit Care Med,2008,12(2):R56.
[6] 刁燕颜,罗萍,余江萍.重症监护病房呼吸机相关性肺炎的相关因素分析及预防[J].广东医学,2016,37(1):137-8,139.
[7] Zagli G,Cozzolino M,Terreni A,et al.Diagnosis of ventilator-associated pneumonia:a pilot,exploratory analysis of a new score based on procalcitonin and chest echography[J].Chest,2014,146(6):1578-85.
[8] 张英民,毛毅敏,孙瑜霞.纤维支气管镜辅助治疗重症呼吸机相关性肺炎的疗效观察[J].中国内镜杂志,2015,21(3):239-42.
[9] 申小侠,徐凤玲,洪静芳.ICU呼吸机相关性肺炎预防控制质量核查单的设计及应用[J].广东医学,2017,38(7):1126-30.
[10] 席红利,杨丽娜,李娟.呼吸机相关性肺炎患者病原菌检测的意义及其PCT、CRP、肺功能的变化研究[J].国际检验医学杂志,2018,39(13):1602-5,1609.
[11] 王红民,张小红,叶立群,等.白细胞介素-35调控CD4+CD25+CD127 dim/-调节性T细胞在呼吸机相关性肺炎发病中的作用[J].中华微生物学和免疫学杂志,2017,37(9):674-80.
[12] 马大文,刘峰.降钙素原监测在老年患者治疗呼吸机相关性肺炎中的作用[J].中国老年学杂志,2017,37(4):925-7.
[13] 梁添书,邬敏志,谭家余,等.中性粒细胞弹性蛋白酶对呼吸机相关性肺炎诊断及转归的评估价值[J].中华危重病急救医学,2016,28(9):785-9.
[14] 韦艳,李晓阳,丁丽丽,等.重症监护病房呼吸机相关性肺炎的危险因素分析[J].中国感染与化疗杂志,2014,14(1):7-10.
[15] 万自芬,余红,夏婧,等.呼吸危重症监护病房患者下呼吸道感染菌分布及多重耐药危险因素分析[J].中国临床医生,2014,42(2):33-5.