呼吸系统感染高毒力肺炎克雷伯菌的分子基因特点

Molecular gene characteristics of highly virulent Klebsiella pneumoniae in patients with respiratory system infection

目的探究呼吸系统感染高毒力肺炎克雷伯菌的分子基因分布特点和患者临床特征。方法选取2017年9月-2018年10月于焦作市人民医院接受治疗的524例肺炎克雷伯菌呼吸系统感染患者为研究对象,其中148例高毒力肺炎克雷伯菌感染患者为观察组,376例普通肺炎克雷伯菌感染患者为对照组。分析两组患者年龄、性别、基础疾病等临床特征;比较两组毒力质粒pLVPK基因中质粒特有序列(rep)、促荚膜合成因子(rmpA)以及铁载体Aerobactin(iuc)等分子基因的分布特征;比较两组患者生活质量评分;比较高毒力肺炎克雷伯菌和普通肺炎克雷伯菌对不同抗菌药物的耐药性。结果两组患者年龄、性别、临床来源、基础疾病、住院天数、痰培养混合菌比较无差异;两组患者最高体温以及胸部CT检查结果比较差异有统计学意义(P<0.05)。分子基因分布特点比较发现,观察组患者rep、rmpA以及iuc阳性率分别为89.86%(133)、79.73%(118)、91.89%(136),均高于对照组(P<0.05)。观察组患者生活质量总分(83.24±12.27)分,低于对照组患者的(115.59±27.04)分,两组比较差异有统计学意义(P<0.05)。高毒力肺炎克雷伯菌和普通肺炎克雷伯菌对氨苄西林耐药性最高,分别为90.54%和97.60%。结论高毒力肺炎克雷伯菌呼吸系统感染患者生活质量水平较低,高毒力肺炎克雷伯菌毒力质粒pLVPK基因阳性率高于普通肺炎克雷伯菌。

OBJECTIVE To explore the molecular gene characteristics of highly virulent Klebsiella pneumoniae in patients with respiratory system infection and observe the clinical characteristics. METHODS A total of 524 patients with K. pneumoniae respiratory system infection who were treated in Jiaozuo People′s Hospital from Sep 2017 to Oct 2018 were recruited as the study objects, 148 patients who had highly virulent K. pneumoniae infection were assigned as the observation group, and 376 patients who had common K. pneumoniae infection were set as the control group.The clinical characteristics of the two groups of patients such as age, gender and underlying diseases were analyzed, the distribution characteristics of the molecular genes such as plasmid specific sequence(rep), Pod synthesis factor(rmpA) and iron carrier aerobactin(iuc) were observed and compared between the two groups;the score of quality of life was compared between the two groups of patients, and the drug resistance rates were compared between the highly virulent K. pneumoniae strains and the common K. pneumoniae strains. RESULTS There were no significant differences in the age, gender, clinical sources, underlying diseases, hospitalization duration and mixed bacteria cultured from sputum between the two groups of patients.There were significant differences in the highest body temperature and result of chest CT examination between the two groups of patients(P<0.05).As compared with the distribution characteristics of the molecular genes, the positive rates of rep, rmpA and iuc of the observation group were respectively 89.86%(133), 79.73%(118) and 91.89%(136), significantly higher than those of the control group(P<0.05).The total score of quality of life of the observation group was(83.24±12.27) points, significantly lower than(115.59±27.04)points of the control group(P<0.05).The drug resistance rate of the highly virulent K. pneumoniae strains to ampicillin was 90.54%, the common K. pneumoniae strains 97.60%. CONCLUSION The quality of life of the patients with highly virulent K. pneumoniae respiratory system infection is poor, and the positive rate of virulence plasmid pLVPK gene of the highly virulent K. pneumoniae strains is higher than that of the common K. pneumoniae strains.