摘要
目的分析呼吸道假丝酵母定植对重症细菌性呼吸机相关性肺炎(VAP)及磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(Akt)/核因子κB(NF-κB)信号通路的影响。方法回顾性分析2019年1月-2022年1月新疆维吾尔自治区人民医院收治的96例重症细菌性VAP患者临床资料,其中51例呼吸道假丝酵母定植阳性(研究组),45例呼吸道假丝酵母定植阴性(对照组)。比较两组临床肺部感染评分(CPIS)等基线资料及呼吸道分泌物细菌分布情况差异,记录两组VAP诊断当日外周静脉血单个核细胞(PBMC)PI3K、Akt、NF-κB表达水平,评估呼吸道假丝酵母定植阳性者CPIS评分与PI3K、Akt、NF-κB表达水平的相关性,记录两组预后转归情况。结果研究组呼吸道分泌物检出61株细菌,对照组检出49株细菌,研究组革兰阳性菌检出率高于对照组(P<0.05)。研究组VAP诊断当日CPIS评分及外周静脉血PBMC PI3K、Akt、NF-κB mRNA相对表达量均高于对照组(P<0.05)。Pearson相关性分析显示,呼吸道假丝酵母定植阳性者VAP诊断当日CPIS评分与外周静脉血PBMC PI3K、Akt、NF-κB mRNA相对表达量呈正相关(r=0.445、0.513、0.677,P均<0.001)。两组28 d死亡率比较,差异无统计学意义,但研究组存活者机械通气时间、重症监护时间及总住院时间均高于对照组(P<0.05)。结论呼吸道假丝酵母定植可影响重症细菌性VAP病原菌分布,并加剧病情进展,增加预后转归所需时间,其作用机制可能与激活PI3K/Akt/NF-κB信号通路有关。
OBJECTIVE To analyze the effects of respiratory tract Candida colonization on severe bacterial ventilator-associated pneumonia(VAP)and phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt)/nuclear factorκB(NF-κB)signaling pathway.METHODS The clinical data of 96 patients with severe bacterial VAP who were admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from Jan 2019 to Jan 2022 were retrospectively analyzed.Among the patients,51 cases were positive for respiratory tract Candida colonization(study group),and 45 cases were negative for respiratory tract Candida colonization(control group).The clinical pulmonary infection score(CPIS),other baseline data and distribution status of bacteria in respiratory secretions were compared between the two groups.And the expression levels of PI3K,Akt and NF-κB in peripheral blood mononuclear cells(PBMCs)in the two groups were recorded on the day of VAP diagnosis.The correlation between CPIS score and expression levels of PI3K,Akt and NF-κB was analyzed in patients with positive respiratory tract Candida colonization were evaluated,and the prognosis and outcomes between the two groups were compared.RESULTS Total of 61 strains of bacteria were detected in the respiratory secretions of study group and 49 strains of bacteria in the control group.The detection rate of gram-positive bacteria in the study group was higher than that in the control group(P<0.05).The CPIS score and mRNA relative expression levels of PI3K,Akt and NF-κB in peripheral venous blood PBMCs on the day of VAP diagnosis were higher in the study group than those in the control group(P<0.05).Pearson correlation analysis showed that the CPIS score on the day of VAP diagnosis in patients with positive respiratory tract Candida colonization was significantly positively correlated with the mRNA relative expressions of PI3K,Akt and NF-κB in peripheral venous blood PBMCs(r=0.445,0.513,0.677,all P<0.001).There was no significance in the 28-day mortality rate between the two groups,but the mechanical ventilation time,intensive care time and total hospital stay of the survivors in the study group were higher than those in the control group(P<0.05).CONCLUSION Respiratory tract Candida colonization can affect the distribution of pathogenic bacteria in patients with severe bacterial VAP,aggravate the disease progression,and increase the time required for prognosis and outcomes.The mechanism may be related to the activation of PI3K/Akt/NF-κB signaling pathway.
作者
孙雅玲
张冬梅
胡帆
卢冬梅
SUN Ya-ling;ZHANG Dong-mei;HU Fan;LU Dong-mei(People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang 8830001,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第7期1006-1010,共5页
Chinese Journal of Nosocomiology
基金
新疆维吾尔自治区人才专项计划-天山青年计划(2020Q045)。
