急诊重症监护室重症肺炎病原菌分布及其耐药性和miRNA表达

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中文摘要：目的探讨急诊重症监护室(EICU)重症肺炎病原菌分布及其耐药性和微小核糖核酸(miRNA)表达。方法选取2019年8月-2023年7月滨州医学院烟台附属医院和烟台市牟平区中医医院收治的107例重症肺炎(肺炎A组)和115例普通肺炎(肺炎B组)患者为研究对象，另选133名同期健康体检者为对照组。统计EICU重症肺炎的病原菌分布和耐药情况;比较三组血清miRNA-21、miRNA-146a、miRNA-127、miRNA-147a水平，受试者工作特征(ROC)曲线分析单独及联合检测对EICU重症肺炎诊断价值。结果 107例EICU重症肺炎患者共分离出病原菌113株，革兰阴性菌多，占比高的有铜绿假单胞菌、肺炎克雷伯菌。铜绿假单胞菌对环丙沙星(89。66％)和庆大霉素(86。21％)耐药性强，肺炎克雷伯菌对头孢吡肟(79。17％)和环丙沙星(83。33％)耐药性强，均对阿米卡星和美罗培南敏感。血清miRNA-21、miRNA-146a、miRNA-127水平肺炎A组＞肺炎B组＞对照组(P＜0。05);血清 miRNA-147a 水平肺炎A组＜肺炎 B组＜对照组(P＜0。05)。miRNA-21、miRNA-146a、miRNA-127、miRNA-147a联合诊断EICU重症肺炎曲线下面积(AUC)高于各项单独检测(P＜0。05)。结论 EICU重症肺炎患者革兰阴性菌感染多，主要病原菌为铜绿假单胞菌、肺炎克雷伯菌，不同病原菌耐药性存在差异，对常用抗菌药物耐药性高;EICU重症肺炎发生后miRNA-21、miRNA-146a、miRNA-127呈高表达，miRNA-147a呈低表达，四者联合检测有助于诊断EICU重症肺炎。

外文标题：Expression of miRNA,distribution and drug resistance of pathogens isolated from emergency intensive care unit patients with severe pneumonia

外文摘要：OBJECTIVE To explore the expression of micro ribonucleic acid(miRNA),distribution and drug resist-ance of pathogens isolated from the emergency intensive care unit(EICU)patients with severe pneumonia.METHODS A total of 107 patients with severe pneumonia(the pneumonia A group)and 115 patients with com-mon pneumonia(the pneumonia B group)who were treated in Yantai Affiliated Hospital of Binzhou Medical Col-lege and Yantai Muping District Hospital of Traditional Chinese Medicine from Aug 2019 to Jul 2023 were recrui-ted as the research subjects.Meanwhile,133 healthy people who received physical examination were chosen as the control group.The distribution and drug resistance of the pathogens isolated from the EICU patients with severe pneumonia were statistically analyzed.The levels of serum miRNA-21,miRNA-146a,miRNA-127 and miRNA-147a were compared among the three groups.The values of the single and joint detection of the indexes in diagno-sis of the severe pneumonia were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 113 strains of pathogens were isolated from the 107 EICU patients with severe pneumonia,among which gram-negative bacteria were dominant,Pseudomonas aeruginosa and Klebsiella pneumoniae were the predomi-nant species.The drug resistance rate of the P.aeruginosa to ciprofloxacin was 89.66％,gentamicin 86.21％;the drug resistance rate of the K.pneumoniae to cefepime was 79.17％,ciprofloxacin 83.33％.Both species were sen-sitive to amikacin and meropenem.As compared with the levels of serum miRNA-21,miRNA-146a and miRNA-127,it was that the pneumonia A group＞the pneumonia B group＞the control group(P＜0.05).As compared with the serum miRNA-147a,it was that the pneumonia A group＜the pneumonia B group＜the control group(P＜0.05).The area under curve(AUC)of the joint detection of miRNA-21,miRNA-146a,miRNA-127 and miRNA-147a was significantly higher than that of the single detection in diagnosis of severe pneumonia in the EICU patients(P＜0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the EICU patients with severe pneumonia;the P.aeruginosa and K.pneumoniae are the predominant spe-cies.The pathogens vary in the drug resistance,and the drug resistance rates to the commonly used antibiotics are high.The EICU patients with severe pneumonia show the high expressions of miRNA-21,miRNA-146a and miR-NA-127 and the low expression of miRNA-147a.The joint detection of the four indexes may facilitate the diagnosis of severe pneumonia in the EICU patients.

外文关键词：

Emergency intensive care unitSevere pneumoniaDrug resistancePathogenMicro ribonucleic acid-21Micro ribonucleic acid-146aMicro ribonucleic acid-127Micro ribonucleic acid-147aDiagnostic value

作者：

孙艺英、徐向青、张伟强

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作者单位：

滨州医学院烟台附属医院急诊内科,山东烟台 264100

烟台市牟平区中医医院综合内科,山东烟台 264100

滨州医学院烟台附属医院重症医学科,山东烟台 264100

关键词：

急诊重症监护室重症肺炎病原菌耐药性微小核糖核酸-21 微小核糖核酸-146a 微小核糖核酸-127 微小核糖核酸-147a 诊断价值

基金：

山东省医药卫生科技计划基金资助项目

项目编号：

2019WS0591

出版年：

2024

DOI：

10.11816/cn.ni.2024-231832

中华医院感染学杂志

中华预防医学会中国人民解放军总医院

中华医院感染学杂志

CSTPCD北大核心

影响因子：1.885

ISSN：1005-4529

年,卷(期)：2024.34(14)