呼吸道菌群负担和多样性与危重患者预后的相关性分析

Correlation analysis between bacterial load and diversity in respiratory tract with prognosis in critical patients

目的探讨重症监护室(ICU)患者呼吸道菌群负荷和多样性与死亡率的相关性。方法选取2016年1月至2020年4月天津医科大学第二医院ICU收治的232例患者为研究对象,根据是否于ICU死亡分为存活组(n=165)和死亡组(n=58)。比较两组一般资料、血生化检测结果、支气管肺泡冲洗回收液中细菌16S rDNA拷贝数、丰度(采用chao、sobs、ace指数)和多样性(simpson和shannon指数)等。对上述指标行单因素分析,并采用logistic多因素回归分析死亡相关因素。结果死亡组急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分、急性肾损伤比例均高于存活组(P<0.05);死亡组16S rDNA拷贝数和simpson指数均高于存活组,chao、sobs、shannon、ace指数均低于存活组(P<0.05);APACHEⅡ评分、SOFA评分、16S rDNA拷贝数为ICU患者死亡危险因素(P<0.05),chao指数、sobs指数、shannon指数、ace指数为保护因素(P<0.05)。结论ICU患者呼吸道细菌负荷和多样性与死亡率相关,肺部微生态紊乱可能影响患者预后。

Objective To explore the correlation between the bacterial load and diversity in respiratory tract with the mortality rate in the intensive care unit(ICU)patients.Methods A total of 232 patients treated in ICU of this hospital from January 2016 to April 2020 were selected as the study subjects and divided into the survival group(n=165)and death group(n=58)according to whether the patients died in ICU.The general data,blood biochemical test results,bacterial 16S rDNA copy number,richness(by chao,sobs,ace indexes)and diversity(by simpson and shannon indexes)in bronchoalveolar lavage fluid were comparanalyzed between the two groups.The univariate analysis was performed on above indicators,and the logistic multiple factors regression was adopted to analyse the death related factors.Results The acute physiology and chronic health evaluation(APACHEⅡ)score,sequential organ failure assessment(SOFA)score and proportion of acute kidney injury in the death group were higher than those in the survival group(P<0.05);the 16S rDNA copy number and simpson index in the death group were higher than those in the survival group,the chao,sobs,shannon,ace indexes in the death group were lower than those in the survival group(P<0.05);the APACHEⅡscore,SOFA score and 16S rDNA copy number were the risk factors of death in ICU patients(P<0.05),while the chao index,sobs index,shannon index and ace index were the protective factors(P<0.05).Conclusion Bacterial load and diversity in respiratory tract of ICU patients are correlated to the mortality rate,and pulmonary micro-ecological disorder may affect the patients′prognosis.