重症肺炎患者病原菌分布与C-反应蛋白和白细胞介素-6及白细胞介素-10的变化研究

Pathogenic bacteria distribution and changes of CRP,IL-6,and IL-10 in patients with severe pneumonia

目的研究重症肺炎患者病原菌分布及C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)的变化,为临床诊治提供参考。方法选取2014年5月-2016年4月医院收治的重症肺炎患者160例为观察组,并同期选择130名健康体检者为对照组,分析感染患者的病原菌分布,并采用酶联免疫吸附测定法检测患者感染病原菌后血清CRP、IL-6及IL-10的水平变化。结果观察组患者分离出病原菌176株,其中革兰阴性菌104株占59.1%,革兰阳性菌33株占18.7%,真菌39株占22.2%;革兰阴性菌中铜绿假单胞菌对阿米卡星的耐药率最低,其次是哌拉西林和美罗培南,肺炎克雷伯菌对亚胺培南的耐药率最低,其次是美罗培南和头孢哌酮,不动杆菌属对头孢哌酮的耐药率最低;革兰阳性菌中金黄色葡萄球菌和表皮葡萄球菌均对青霉素的耐药率最高,屎肠球菌对环丙沙星和青霉素的耐药率最高;另外患者感染病原菌后血清CRP、IL-6以及IL-10表达水平均明显高于健康的体检者,两组比较差异有统计学意义(P<0.05)。结论重症肺炎患者病原菌是以革兰阴性菌为主,对抗菌药物具有较高的耐药性,且血清CRP、IL-6及IL-10水平均明显升高。

OBJECTIVE To investigate pathogenic bacteria distribution and changes of CRP,IL-6,and IL 10 in patients with severe pulmonary infection so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 160 cases of patients with severe pulmonary infection from May 2014 to Apr.2016 were selected as observation group,and 130 healthy subjects were selected as control group at the same period.The pathogenic bacteria distribution of infected patients was analyzed,and the changes of serum CRP,IL-6 and IL-10 levels after infection were detected using enzyme-linked immunosorbent assay.RESULTS There were 176 strains of pathogens isolated from 160 patients with severe pulmonary infection,among which gram-negative bacteria accounted for 59.1 % （104 strains）,gram-positive bacteria accounted for 18.7% （33 strains）,and fungi accounted for 22.2% （39 strains）.Among gram negative bacteria,Pseudomonas aeruginosa had the lowest resistant rate to amikacin,followed by piperacillin and meropenem,Klebsiella pneumonia had the lowest resistant rate to imipenem,followed hy rneropenem and cefoperazone,and Acinetobacter had the lowest resistant rate to cefoperazone.Among grampositive bacteria,Staphylococcus aureus and Staphylococcus epidermidis had the highest resistant rate to penicillin,and Enterococcus faecium had the highest resistant rate to ciprofloxacin and penicillin.In addition,the levels of CRP,IL-6 and IL-10 of observation group were significantly higher than those of control group （P〈0.05）.CONCLUSION The pathogenic bacteria in patients with severe pulmonary infection are mainly gram-negative bacteria,which have high resistant rates to antibiotics,and serum CRP,IL-6 and IL-10 levels are significantly in creased.