急性重症颅脑损伤继发肺部感染miRNA表达及主要病原菌耐药性

Expression of miRNA in acute severe craniocerebral injury patients with secondary pulmonary infection and drug resistance of major species of pathogens

目的探讨急性重症颅脑损伤继发肺部感染微小核糖核酸(miR)-34a、miR-146a、miR-122-5p表达,并分析其主要病原菌耐药性。方法选取2021年9月-2023年9月济南市人民医院收治的急性重症颅脑损伤继发肺部感染患者106例为感染组,根据病情分为轻、中和重度三组,分别为28、46和32例,另选110例未继发肺部感染患者为未感染组。分析感染组病原菌分布及耐药性,比较感染组和未感染组及感染组不同病情患者血清miR-34a、miR-146a、miR-122-5p水平及预测价值。结果106例感染患者检出病原菌113株,其中革兰阴性菌检出最多,为78株(69.03%)。铜绿假单胞菌、鲍氏不动杆菌对头孢噻肟、他唑巴坦的耐药率较高,对舒巴坦均敏感。与未感染组比,感染组血清miR-34a、miR-146a水平更高(P<0.05),血清miR-122-5p水平更低(P<0.05)。随着感染组患者病情加重,血清miR-34a、miR-146a水平递增(P<0.05),血清miR-122-5p水平递减(P<0.05)。血清miR-34a、miR-146a、miR-122-5p联合检测预测急性重症颅脑损伤继发肺部感染的曲线下面积高于三指标单一检测(P<0.05)。结论革兰阴性菌为急性重症颅脑损伤继发肺部感染患者主要致病菌,不同病原菌耐药情况不同,血清miR-34a、miR-146a在急性重症颅脑损伤继发肺部感染患者中呈高表达,而血清miR-122-5p呈低表达,三指标可参与患者病情进展过程,且联合检测的预测价值更高。

OBJECTIVE To explore the expressions of micro ribonucleic acid(miR)-34a,miR-146a and miR-122-5p in the acute severe craniocerebral injury patients with secondary pulmonary infection and analyze the drug resistance of the major species of pathogens.METHODS A total of 106 acute severe craniocerebral injury patients with secondary pulmonary infection who were treated in Jinan People′s Hospital from Sep.2021 to Sep.2023 were assigned as the infection group and were divided into the mild group with 28 cases,the moderate group with 46 cases and the severe group with 32 cases.Meanwhile,110 patients who did not have secondary pulmonary infection were chosen as the no infection group.The distribution and drug resistance of pathogens isolated from the infection group were analyzed.The levels of serum miR-34a,miR-146a and miR-122-5p were observed and compared between the infection group and the no infection group and among the patients with different illness condition in the infection group.The predictive values of the above indexes were analyzed.RESULTS Totally 113 strains of pathogens were isolated from the 106 patients with infection,78(69.03%)of which were gram-negative bacteria.The drug resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii strains to cefotaxime and tazobactam were high,while the strains were susceptible to sulbactam.The levels of serum miR-34a and miR-146a of the infection group were higher than those of the no infection group(P<0.05),while the serum miR-122-5p level of the infection group was lower than that of the no infection group(P<0.05).The levels of serum miR-34a and miR-146a were elevated with the aggravation of illness condition(P<0.05),while the serum miR-122-5p level declined(P<0.05).The area under curve of the joint detection of serum miR-34a,miR-146a and miR-122-5p was higher than that of the single detection in prediction of the secondary pulmonary infection in the acute severe craniocerebral injury patients(P<0.05).CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the acute severe craniocerebral injury patients with secondary pulmonary infection.The pathogens vary in the drug resistance.The patients show the high expressions of serum miR-34a and miR-146a but show the low expression of serum miR-122-5p.The three indexes may get involved in the progression of illness condition,and the predictive value of the joint detection is higher.