SP-D基因多态性与老年支气管哮喘急性发作合并肺部感染的易感性

Association between SP-D gene polymorphism and susceptibility to pulmonary infection in elderly patients with acute attach of bronchial asthma

目的 分析老年哮喘急性发作合并肺部感染与肺泡表面活性蛋白D(SP-D)基因多态性的相关性。方法 选取2018年10月-2020年10月商丘市第一人民医院收治的107例老年哮喘急性发作合并肺部感染患者为研究组,同期老年哮喘急性发作未合并肺部感染患者129例为对照组,收集感染患者痰液样本进行病原菌培养和药敏试验,采集两组患者外周静脉血检测SP-D基因多态性。结果 107例老年哮喘急性发作合并肺部感染患者痰液标本共培养出病原菌126株,其中革兰阴性菌77株占61.11%、革兰阳性菌38株占30.16%、真菌11株占8.73%。常见革兰阴性菌对氨苄西林、阿莫西林、庆大霉素、磺胺甲噁唑/甲氧苄啶及头孢类抗菌药物耐药率较高,对环丙沙星、亚胺培南及美罗培南耐药率相对较低;常见革兰阳性菌对青霉素G、克林霉素和红霉素耐药率较高,对万古霉素、左氧氟沙星和磺胺甲噁唑/甲氧苄啶耐药率相对较低。研究组rs2243639位点G等位基因以及rs721917位点CC基因型和C等位基因分布频率均高于对照组(P<0.05)。结论 老年哮喘急性发作合并肺部感染患者病原菌分布范围较广且对常用抗菌药物普遍存在耐药现象,感染发生可能与SP-D基因rs2243639位点G等位基因和rs721917位点C等位基因相关。

OBJECTIVE To analyze the association between the pulmonary infection in elderly patients with acute attack of bronchial asthma and alveolar surfactant protein D(SP-D) gene polymorphism. METHODS A total of 107 elderly patients with acute attack of bronchial asthma who were complicated with pulmonary infection and treated in The First People′s Hospital of Shangqiu City from Oct 2018 to Oct 2020 were assigned as the study group, meanwhile, 129 elderly patients with acute attack of bronchial asthma who were not complicated with pulmonary infection were chosen as the control group. Sputum specimens were collected from the patients with infection, pathogens were isolated, and drug susceptibility testing was performed, and peripheral blood specimens were collected from the two groups of patients so as to detect the SP-D gene polymorphism. RESULTS Totally 126 strains of pathogens were isolated from the sputum specimens of the 107 elderly patients with acute attack of bronchial asthma and pulmonary infection, 77(61.11%) of which were gram-negative bacteria, 38(30.16%) were gram-positive bacteria, and 11(8.73%) were fungi. The drug resistance rates of the commons species of gram-negative bacteria to ampicillin, amoxicillin, gentamicin, sulfamethoxazole-trimethoprim and cephalosporins were relatively high, while the drug resistance rates to ciprofloxacin, imipenem and meropenem were relatively low. The drug resistance rates of the common species of gram-positive bacteria to penicillin G, clindamycin and erythromycin were relatively high, while the drug resistance rates to vancomycin, levofloxacin and sulfamethoxazole-trimethoprim were relatively low. The distribution frequencies of G allele at rs2243639 locus and genotype CC and C allele at rs721917 locus were significantly higher in the study group than in the control group(P<0.05). CONCLUSION The elderly patients with acute attack of bronchial asthma and pulmonary infection show broad spectrum of pathogens, which are generally resistant to the commonly used antibiotics. The incidence of the pulmonary infection may be associated with the G allele at rsrs2243639 locus and C allele at rs721917 locus of SP-D gene.