呼吸机相关性肺炎患者病原菌分布及血清sTREM-1和HMGB1的变化

Distribution of pathogenic bacteria and changes of serum sTREM-1and HMGB1in patients with ventilator-associated pneumonia

目的探讨呼吸机相关性肺炎患者病原菌分布及血清高迁移率族蛋白1(HMGB1)和可溶性髓系细胞触发受体-1(sTREM-1)的变化。方法选取我院2016年3月至2019年5月收治的131例呼吸机相关性肺炎患者进行研究,检测入选患者病原菌感染情况,同时根据患者病情分为重症组与非重症组。另选取60例同期体检对象作为对照组,比较各组患者血清sTREM-1、HMGB1水平及临床肺部感染评分(CPIS),分析血清sTREM-1、HMGB1对呼吸机相关性肺炎的预测价值。结果131例患者共检出病原菌415株,病原菌以革兰阴性菌为主,其次是革兰阳性菌,真菌的占比最低。革兰阴性菌中以铜绿假单胞菌和肺炎克雷伯菌为主,革兰阳性菌中以金黄色葡萄球菌为主。重症组、非重症组及对照组患者血清sTREM-1、HMGB1水平及CPIS评分依次递减,组间比较差异均有统计学意义(均P<0.05)。Cochran Armitage趋势检验发现,血清sTREM-1、HMGB1水平及CPIS评分与呼吸机相关性肺炎严重程度呈线性增加趋势(Z=5.056、3.127、3.811,均P<0.05)。诊断呼吸机相关性肺炎病情严重程度时,血清sTREM-1的AUC及敏感性、特异性最高,其次是CPIS和血清HMGB1,3个指标均对呼吸机相关性肺炎有一定诊断价值。结论革兰阴性菌是呼吸机相关性肺炎的主要致病菌,血清sTREM-1、HMGB1水平对呼吸机相关性肺炎的病情有一定诊断价值。

Objective To investigate the distribution of pathogenic bacteria and the changes of serum high mobility group protein 1(HMGB1)and soluble myeloid cell trigger receptor-1(sTREM-1)in patients with ventilator-associated pneumonia.Methods A total of 131patients with ventilator-associated pneumonia admitted to our hospital from March 2016to May 2019were enrolled.According to their condition,they were divided into severe condition group or non-severe condition group.Another 60healthy subjects during the same period were selected as control group.Serum levels of sTREM-1and HMGB1and clinical pulmonary infection scores were compared among the groups.The predictive value of serum sTREM-1and HMGB1for ventilator-associated pneumonia was analyzed by using CPIS.Results A total of 415strains of pathogenic bacteria were detected.Gram-negative bacteria were the main pathogenic bacteria,followed by Gram-positive bacteria;the proportion of fungi was the lowest.Pseudomonas aeruginosa and Klebsiella pneumoniae were predominant in Gram-negative bacteria,while Staphylococcus aureus was predominant in Gram-positive bacteria.The levels of serum sTREM-1and HMGB1and CPIS scores in severe condition group,non-severe condition group and control group decreased in turn,with significant differences between groups(all P<0.05).Cochran Armitage trend test showed that serum levels of sTREM-1and HMGB1and CPIS scores increased linearly with the severity of ventilator-associated pneumonia(Z=5.056,3.127,3.811;all P<0.05).When predicting the occurrence of ventilator-associated pneumonia,the AUC,sensitivity and specificity of serum sTREM-1were the highest,followed by CPIS and serum HMGB1.All the three indicators had certain predictive value for ventilator-associated pneumonia.Conclusion Gram-negative bacteria are the main pathogens of ventilator-associated pneumonia.Serum levels of sTREM-1and HMGB1have certain predictive value for the occurrence of the disease.