呼吸道假丝酵母定植与细菌性呼吸机相关性肺炎的关系

Association between respiratory tract Candida colonization and ventilator-associated pneumonia

目的探究呼吸道假丝酵母定植与细菌性呼吸机相关性肺炎(VAP)的关系。方法法选取阜阳市第二人民医院150例细菌性VAP患者为研究对象,根据是否发生呼吸道假丝酵母定植分为定植组67例和非定植组83例,比较两组呼吸道分泌物中细菌菌株分布情况、呼吸道分泌物中淀粉样蛋白(SAA)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)水平,分析SAA、CRP和IL-6水平与定植组临床指标的相关性及其对呼吸道假丝酵母定植的诊断价值。结果定植组革兰阳性菌检出率高于非定值组(P<0.05);定植组VAP确诊时机械通气天数低于非定植组(P<0.05),发热、痰量增多、痰液性状改变占比、呼吸道分泌物中β-葡聚糖水平、SAA、CRP及IL-6水平、临床肺部感染评分(CPIS)高于非定植组(P<0.05);Pearson相关系数分析显示,SAA、CRP及IL-6水平与定植组VAP确诊时机械通气天数、CPIS评分、β-葡聚糖均呈正相关(P<0.05);受试者工作特征(ROC)曲线显示,SAA、CRP及IL-6水平单独及联合预测细菌性VAP患者呼吸道假丝酵母定植的曲线下面积(AUC)为0.720、0.7230.750和0.883,联合诊断价值更高(P<.0.05)。结论呼吸道假丝酵母定植可加快细菌性VAP患者病情进展,其通过影响SAA、CRP和IL-6表达调控机体免疫失衡,可作为细菌性VAP重点监测内容。

OBJECTIVE To explore the association between respiratory tract Candida colonization and ventilator-as-sociated pneumonia(VAP).METHODS A total of 150 patients with bacterial VAP who were treated in the Second People's Hospital of Fuyang City were recruited as the research subjects and were divided into the colonization group with 67 cases and the non-colonization group with 83 cases according to the status of respiratory tract Can-dida colonization.The isolation rates of bacteria strains from respiratory tract secretions and the levels of serum amyloid A(SAA)protein,C-reactive protein(CRP)and interleukin-6(IL-6)in respiratory tract secretions were compared between the two groups.The association between the levels of SAA,CRP and IL-6 and the clinical inde-xes of the colonization group was observed,and the value of the indexes in diagnosis of respiratory tract Candida colonization was analyzed.RESULTS The isolation rate of gram-positive bacteria of the colonization group was higher than that of the non-colonization group(P<o.05).The mechanical ventilation duration of the colonization group was shorter than that of the non-colonization group when VAP was diagnosed(P<0.05).The percentages of patients with fever,increased volume of sputum and change of sputum characteristic,levels of β-glucan,SAA,CRP and IL-6 in respiratory tract secretions and clinical pulmonary infection score(CPIS)were higher in the colonization group than in the non-colonization group(P<o.05).Pearson related coefficient analysis showed that the levels of SAA,CRP and IL-6 were positively correlated with mechanical ventilation duration,CPIS score andβ-glucan of the colonization group when VAP was diagnosed(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the areas under curves(AUCs)of SAA,CRP,IL-6 and the joint detection of the three indexes were respectively 0.720,0.723,0.750 and 0.883 in prediction of respiratory tract Candida colonization of the patients with bacterial VAP,and the diagnostic value of the joint detection was higher(P<0.05).CONCLUSION The respiratory tract Candida colonization may accelerate the progression of illness condition of the patients with bacterial VAP and regulate the immune imbalance by affecting the expressions of SAA,CRP and IL-6,which the bacterial VAP should be focused on.