特发性肺间质纤维化急性加重患者呼吸道微生态成分与不良预后的关系

Relationship between respiratory microecological components and adverse prognosis in patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis

目的分析特发性肺间质纤维化急性加重患者呼吸道微生态成分与不良预后的关系。方法选取2020年1月—2021年1月四川省南充市中心医院呼吸与危重症医学科诊治特发性肺间质纤维化急性加重患者98例作为研究组,并根据预后情况分为预后良好亚组54例和预后不良亚组44例,另外选取同期特发性肺间质纤维化稳定期患者50例作为对照组。检测并比较2组患者及不同预后特发性肺间质纤维化急性加重患者体内细菌丰度(chao指数、sobs指数、ace指数)、多样性(shannon指数、simpson指数)、菌门(拟杆菌门、厚壁菌门、变形菌门、放线菌门)的表达变化,受试者工作特征曲线(ROC)分析微生态成分对特发性肺间质纤维化急性加重患者不良预后的诊断价值。结果与对照组比较,研究组chao指数、sobs指数、ace指数、shannon指数及拟杆菌门、放线菌门占比降低(t=6.361、8.253、4.440、6.483、18.680、10.610,P均<0.001),simpson指数及厚壁菌门、变形菌门占比均升高(t=6.955、14.230、13.730,P均<0.001)。与预后良好亚组比较,预后不良亚组chao指数、sobs指数、ace指数、shannon指数及拟杆菌门、放线菌门占比降低(t=6.709、8.061、4.653、11.530、11.540、5.083,P均<0.001),simpson指数及厚壁菌门、变形菌门占比升高(t=3.776、4.390、8.017,P均<0.001)。ROC曲线显示,chao指数、sobs指数、ace指数、simpson指数、shannon指数、拟杆菌门、厚壁菌门、变形菌门、放线菌门及联合检测诊断特发性肺间质纤维化急性加重患者不良预后的AUC为0.709、0.751、0.679、0.709、0.777、0.724、0.732、0.688、0.697、0.908,联合检测价值高于单项指标检测。结论呼吸道微生态成分与特发性肺间质纤维化急性加重患者病情相关,且微生物成分紊乱可影响患者预后,检测其表达可对患者不良预后进行诊断。

Objective To analyze the relationship between respiratory microecological components and adverse prognosis in patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis.Methods From January 2020 to January 2021,98 patients with acute exacerbation of idiopathic pulmonary fibrosis diagnosed and treated by the Department of Respiratory and Critical Care Medicine of Nanchong Central Hospital in Sichuan Province were selected as the study group,and were divided into 54 subgroups with good prognosis and 44 subgroups with poor prognosis according to the prognosis.In addition,50 patients with stable idiopathic pulmonary fibrosis were selected as the control group.Detect and compare the expression changes of bacterial abundance(chao index,sobs index,ace index),diversity(shannon index,simpson index),and bacteria(Bacteroides,Firmicutes,Proteus,Actinomycetes)in the two groups of patients and patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis with different prognosis,The diagnostic value of microecological components in the poor prognosis of patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis was analyzed by receiver operating characteristic curve(ROC).Results Compared with the control group,the chao index,sobs index,ace index,shannon index and the proportion of Bacteroides and Actinomyces in the study group decreased(t=6.361,8.253,4.440,6.483,18.680,10.610,P<0.001),and the simpson index and the proportion of Firmicutes and Proteus increased(t=6.955,14.230,13.730,P<0.001).Compared with the subgroup with good prognosis,the chao index,sobs index,ace index,shannon index and the proportion of Bacteroides and Actinomycetes in the subgroup with poor prognosis decreased(t=6.709,8.061,4.653,11.530,11.540,5.083,P<0.001),and the simpson index and the proportion of Firmicutes and Proteus increased(t=3.776,4.390,8.017,P<0.001).ROC curve shows that the AUC of chao index,sobs index,ace index,simpson index,shannon index,Bacteroides,Firmicutes,Proteus,Actinomycetes and their combined detection for the diagnosis of adverse prognosis in patients with acute exacerbation of idiopathic pulmonary fibrosis is 0.709,0.751,0.679,0.709,0.777,0.724,0.732,0.688,0.697,0.908,and the combined detection value is higher than that of single indicator detection.Conclusion Respiratory microecological composition is related to the condition of patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis,and the disorder of microbial composition can affect the prognosis of patients.Detection of its expression can diagnose the poor prognosis of patients.