支气管扩张急性感染患者炎性因子表达水平与病原菌分布及耐药性分析

Expression of inflammatory factors in bronchiectasis patients complicated with acute infections,distribution and drug resistance of pathogens

目的探讨支气管扩张急性感染患者炎性因子表达水平,并分析病原菌分布及耐药性。方法选取2012年10月-2016年10月医院呼吸内科收治的支气管扩张患者298例,根据合并急性感染情况将患者分为支气管扩张急性感染组(178例)及支气管扩张非急性感染组(120例),所有患者行病原菌培养,检测白介素-6(IL-6)、白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)含量,对结果进行分析。结果支气管扩张非急性感染组患者血清IL-6、IL-8及TNF-α表达水平均低于支气管扩张急性感染组患者,(t=2.42,P=0.001;t=11.00,P<0.001;t=8.11,P<0.001);178例支气管扩张急性感染患者共检出病原菌126株,分离率为70.79%,革兰阴性菌共93株,以铜绿假单胞菌44株,肺炎克雷伯菌17株最常见,革兰阳性菌17株,真菌16株;革兰阴性菌中铜绿假单胞菌对头孢哌酮、氨苄西林耐药率最高,为90.91%及95.45%;肺炎克雷伯菌对头孢哌酮、氨苄西林、头孢吡肟耐药率最高,为88.24%。结论支气管扩张急性感染患者血清炎症因子IL-6、IL-8、TNF-α水平增高,主要致病菌为革兰阴性菌,其对抗菌药物亚胺培南及美罗培南相对敏感。

OBJECTIVE To explore the levels of expression of inflammatory factors in bronchiectasis patients complicated with acute infection and investigate the distribution and drug resistance of pathogens.METHODS A total of298 patients with bronchiectasis who were treated in respiratory medicine department of the hospital from Oct2012 to Oct 2016 were enrolled in the study and divided into the bronchiectasis acute infection group with 178 cases and the bronchiectasis non-acute infection group with 120 cases according to the status of complication with acute infections.The culture of pathogens was carried out for all of the patients,and the levels of interleukin-6（IL-6）,interleukin-8（IL-8）and tumor necrosis factor-α（TNF-α）were detected and compared between the two groups of patients.RESULTS The levels of serum IL-6,IL-8 and TNF-αof the bronchiectasis non-acute infection group were significantly lower than those of the bronchiectasis acute infection group（t=2.42,P=0.001;t=11.00,P〈0.001;t=8.11,P〈0.001）.Totally 126 strains of pathogens were isolated from the 178 bronchiectasis patients complicated with acute infection,with the isolation rate 70.79%,93 of which were gram-negative bacteria,17 were gram-positive bacteria,and 16 were fungi Pseudomonas aeruginosa（44 strains）and Klebsiella pneumoniae（17 strains）were the most common species of the gram-negative bacteria.Among the gram-negative bacteria,the drug resistance rates of the P.aeruginosastrains to cefoperazone and ampicillin were 90.91%and 95.45%,respectively,and the drug resistance rates of the K.pneumoniae strains to cefoperazone,ampicillin and cefepime were88.24%.CONCLUSION The levels of serum inflammatory factors IL-6,IL-8 and TNF-αof the bronchiectasis patients complicated with acute infection are elevated,the gram-negative bacteria are dominant among the pathogens and are highly susceptible to imipenem and meropenem.