呼吸机相关性肺炎患者病原菌耐药性及其与PI3K/AKT通路的关系

Pathogenic bacteria resistance in patients with ventilator-associated pneumonia and its relationship with the PI3K/AKT pathway

目的探讨呼吸机相关性肺炎患者病原菌耐药性及其与磷脂酰肌醇3-激酶(PI3K)/丝氨酸/苏氨酸激酶(AKT)通路的关系。方法回顾性分析2021年1月-2023年6月安徽医科大学附属安庆第一人民医院神经外科重症监护病房收治的40例行机械通气后发生呼吸机相关性肺炎患者的临床资料作为研究组,同期41例未发生呼吸机相关性肺炎患者的临床资料作为对照组;统计呼吸机相关性肺炎的病原菌耐药性情况;采用实时荧光定量聚合酶链式反应(RT-qPCR)检测外周血PI3KmRNA、AKTmRNA表达情况;采用受试者工作特征(ROC)曲线分析以上指标对呼吸机相关性肺炎的诊断价值。结果呼吸机相关性肺炎患者共培养分离病原菌47株,以肺炎克雷伯菌、铜绿假单胞菌和鲍氏不动杆菌为主;肺炎克雷伯菌对头孢曲松(83.33%)和氨苄西林(100.00%)耐药率较高,而对美罗培南和亚胺培南较敏感;铜绿假单胞菌对头孢曲松(91.67%)和氨芊西林(100.00%)耐药率较高,鲍氏不动杆菌对头孢曲松(90.91%)和哌拉西林(100.00%)耐药率较高,而两者均对庆大霉素较敏感;研究组外周血PI3KmRNA、AKTmRNA为3.14±0.99、2.56±0.85均高于对照组(P<0.05);PI3KmRNA、AKTmR-NA联合诊断呼吸机相关性肺炎的曲线下面积(AUC)高于各项单独检测(P<0.05)。结论呼吸机相关性肺炎发生后PI3K/AKT通路被激活,联合检测外周血PI3KmRNA、AKTmRNA有助于诊断呼吸机相关性肺炎。

OBJECTIVE To investigate pathogenic bacterial resistance in patients with ventilator-associated pneumo-nia and its relationship with the phosphatidylinositol 3-kinase(PI3K)/serine/threonine kinase(AKT)pathway.METHODS The clinical data of 4O patients with ventilator-associated pneumonia after mechanical ventilation in the intensive care unit of the Anqing First People's Hospital affiliated to Anhui Medical University from January 2021 to June 2023 were retrospectively analyzed and set up as the study group,and the clinical data of 4l patients with-out ventilators associated pneumonia during the same period were retrospectively analyzed and set up as the control group.The drug resistance of pathogenic bacteria in ventilator-associated pneumonia was analyzed.Real-time fluo-rescence quantitative polymerase chain reaction(RT-qPCR)was used to detect the expression of PI3K mRNA and AKT mRNA in peripheral blood.The diagnostic value of the above indicators for ventilator-associated pneumonia was analyzed using receiver operating characteristic(ROC)curve analysis.RESULTS Totally 47 strains of pathogens were co-cultured from patients with ventilator-associated pneumonia,including Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter bauerii.Klebsiella pneumoniae had high resistance to ceftriaxone(83.33%)and ampicillin(100.00%),while it was more sensitive to meropenem and imipenem.Pseudomonas aeraerosa had high resistance to ceftriaxone(91.67%)and ampicillin(100.00%),Acinetobacter bauerii had high resistance to ceftriaxone(90.91%)and piperacillin(100.00%),while both were more sensitive to gentamicin.The PI3K mRNA and AKT mRNA in peripheral blood of the study group were 3.14±0.99 and 2.56±0.85,respectively,both higher than those of the control group(P<0.05).The AUC of PI3K mRNA combined with AKT mRNA for the diagnosis of ventilator-associated pneumonia was higher than that of each single test(P<o.05).CONCLUSION The PI3K/AKT pathway was activated after the occurrence of ventilator-associated pneumonia,and the combined detection of PI3K mRNA and AKT mRNA in peripheral blood was helpful for the diagnosis of ventilator-associated pneumonia.