Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

BACKGROUND The number of patients undergoing solid organ transplantation has increased annually.However,infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants.Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4’’-O-isovaleryltransferase gene(ist)from streptomyces thermotoleran.Carrimycin has good antibacterial and antiviral effects.However,no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia(SP)after solid organ transplantation.AIM To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.METHODS In March 2022,ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022.When the condition was critical and difficult to control with other drugs,carrimycin was administered.These ten patients'clinical features and treatment protocols were retrospectively analyzed,and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.RESULTS All ten patients were included in the analysis.Regarding etiological agent detection,there were three cases of fungal pneumonia,two cases of bacterial pneumonia,two cases of Pneumocystis pneumonia,and three cases of mixed infections.After treatment with carrimycin,the disease in seven patients significantly improved,the course of the disease was significantly shortened,fever was quickly controlled,chest computed tomography was significantly improved,and oxygenation was significantly improved.Finally,the patients were discharged after curing.One patient died of acute respiratory distress syndrome,and two patients discontinued treatment.CONCLUSION Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation.Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.

Time to recovery from severe pneumonia and its predictors among pediatric patients admitted in Mizan-Tepi University Teaching Hospital,South West Ethiopia,2022

Objective:Despite trials and programs for the prevention of childhood mortality due to pneumonia,Ethiopia is among the top five countries with the highest number of deaths due to pneumonia.Although the prevalence of pneumonia has increased in the abovementioned trials,little is known about the recovery time from severe pneumonia and its predictors in the study area.Therefore,this study aimed to assess the time to recovery from severe pneumonia and its predictors among pediatric patients admitted to Mizan-Tepi University Teaching Hospital,Ethiopia,in 2022.Methods:A total of 591 children admitted for severe pneumonia were selected using simple random sampling.Data were entered into Epi-data version 4.4.2.1 and expor ted to STATA version 14 for analysis,and the assumptions of Cox propor tional hazard models and goodness of fit were assessed through Shoenfeld residual and Cox-Snell residual,respectively.Bivariate and multivariable Cox regression models were used to identify the predictors of mor tality.Results:This study revealed that 91.54%(95%confidence interval[CI]:89.00–93.53)of participants recovered with an incidence rate of 24.10(95%CI:22.15–26.21)per 100 person-day–observations.The hmedian recovery time of children was 4 days(95%CI:2–6).Children who were not exclusively breastfed(AHR=1.3;95%CI:1.03–1.66),who had a history of inability to suck/feed(AHR=0.81;95%CI:0.65–0.99)were independent predictors of the time to recovery.Conclusions:Children with severe pneumonia who had not exclusively breastfed and who had a history of inability to suck/feed were independent predictors of time to recovery.Therefore,all stakeholders and concerned health care providers should focus more on early diagnosis and management and hasten early recovery based on the identified factors.

Accidental placement of venous return catheter in the superior vena cava during venovenous extracorporeal membrane oxygenation for severe pneumonia: A case report

BACKGROUND Venovenous extracorporeal membrane oxygenation(V-V ECMO)has become an important treatment for severe pneumonia,but there are various complications during the treatment.This article describes a case with severe pneumonia success-fully treated by V-V ECMO,but during treatment,the retrovenous catheter,which was supposed to be in the right internal vein,entered the superior vena cava directly in the mediastinum.The ECMO was safely withdrawn after multidiscip-linary consultation.Our experience with this case is expected to provide a reference for colleagues who will encounter similar situations.CASE SUMMARY A 64-year-old man had severe pulmonary infection and respiratory failure.He was admitted to our hospital and was given ventilation support(fraction of inspired oxygen 100%).The respiratory failure was not improved and he was treated by V-V ECMO,during which the venous return catheter,which was supposed to be in the right internal vein,entered the superior vena cava directly in the mediastinum.There was a risk of massive mediastinal bleeding if the catheter was removed directly when the ECMO was withdrawn.Finally,the patient underwent vena cava angiography+balloon attachment+ECMO with-drawal in the operating room(prepared for conversion to thoracotomy for vascular exploration and repair at any time during surgery)after multidiscip-linary consultation.ECMO was safely withdrawn,and the patient recovered and was discharged.CONCLUSION Patients may have different vascular conditions.Multidisciplinary cooperation can ensure patient safety.Our experience will provide a reference for similar cases.

Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia

BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.METHODS We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1,2021 and December 31,2023.We compared and analyzed the respiratory mechanical indexes[airway resistance(Raw),mean airway pressure(mPaw),peak pressure(PIP)],blood gas analysis indexes(arterial oxygen saturation,arterial oxygen partial pressure,and oxygenation index),and serum inflammatory factor levels[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),and high mobility group protein B1(HMGB1)]of all patients before and after treatment.RESULTS Before treatment,there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups(P>0.05).However,after treatment,the respiratory mechanical indexes of patients in both groups were significantly improved,and the improvement of Raw,mPaw,plateau pressure,PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group(P<0.05).The serum CRP and PCT levels of patients were significantly decreased,and the difference was statistically significant compared with that of nursing group alone(P<0.05).The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.CONCLUSION The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators,blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Analysis of the Efficacy of Xuebijing Combined with Antimicrobials in the Treatment of Intensive Care Unit Patients with Severe Pneumonia

Objective:To analyze the therapeutic effect of Xuebijing+antimicrobials in intensive care unit(ICU)patients with severe pneumonia.Methods:60 ICU patients with severe pneumonia from June 2021 to June 2023 were selected and divided by the random number table method,with 30 cases in each group.The observation group received Xuebijing+antimicrobial treatment,while the control group received only antimicrobial treatment.The differences in rehabilitation indexes,test indexes,and inflammation indexes were compared between the two groups.Results:Mechanical ventilation time,fever reduction time,cough relief time,and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05);C-reactive protein,procalcitonin,and white blood cell count of the observation group were significantly lower than those of the control group(P<0.05);interleukin-6 and tumor necrosis factor-aαof the observation group were significantly lower than those of the control group(P<0.05).Conclusion:The treatment of severe pneumonia patients in ICU with Xuebijing+antibacterial drugs can reduce inflammation,enhance immune function,shorten the pneumonia recovery time,and reduce the adverse reactions of severe pneumonia.

The Effect of Personalized Comprehensive Care on the Nursing Care of Severe Pneumonia Patients

Objective:To explore the value of receiving personalized comprehensive care for patients with severe pneumonia.Methods:73 patients with severe pneumonia who visited the clinic from February 2020 to February 2023 were included in this study.The patients were randomly grouped into Group A and Group B.Group A received personalized comprehensive care whereas Group B received conventional care.The value of care was compared.Results:The duration of mechanical ventilation time,the time taken for fever and dyspnea relief,and the hospitalization time of Group A were shorter than those in Group B(P<0.05).The blood gas indexes such as PaO_(2),PaCO_(2),and blood pH of Group A were better than those of Group B(P<0.05).The pulmonary function indexes such as peak expiratory flow(PEF),forced vital capacity(FVC),and forced expiratory volume in 1 second(FEV_(1))of Group A were better than those of Group B,P<0.05.Moreover,the patients in Group A were generally more satisfied with the care given compared to the patients in Group B(P<0.05).Conclusion:Personalized comprehensive care improves blood gas indexes,enhances lung function,accelerates the relief of symptoms,and also enhances patient satisfaction in severe pneumonia patients.

Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

SAA、内毒素联合SPA检测在重症肺炎诊治中的临床意义

目的 观察重症肺炎患者血清淀粉样蛋白A(SAA)、内毒素、肺表面活性蛋白(SPA)的表达水平,探究三者在重症肺炎诊治中的临床意义。方法 选取2019年1月至2022年12月黄山首康医院收治的102例重症肺炎患者作为研究对象,另选取同期轻症肺炎患者95例,以及同期体检健康人群96名,分别设为重症肺炎组(n=102),轻症肺炎组(n=95)以及对照组(n=96)。比较3组SAA、内毒素、SPA水平,比较重症肺炎组与轻症肺炎组肺炎严重程度(PSI)评分;采用Spearman分析SAA、内毒素和SPA水平与PSI评分的相关性;根据预后情况将重症肺炎组患者分为预后良好组和预后不良组,比较两组SAA、内毒素、SPA水平和PSI评分;分析重症肺炎患者预后的影响因素;分析SAA、内毒素和SPA水平单一及联合检测对重症肺炎预后的评估价值。结果 SAA、内毒素、SPA水平:重症肺炎组>轻症肺炎组>对照组,PSI评分:重症肺炎组>轻症肺炎组,差异均有统计学意义(P<0.05);经Spearman相关性分析,SAA、内毒素、SPA水平与PSI评分均呈正相关(r=0.653、0.682、0.734,P均<0.05);根据预后情况将102例重症肺炎患者分为预后良好组(n=86)和预后不良组(n=16),预后不良组SAA、内毒素、SPA水平和PSI评分均高于预后良好组,差异有统计学意义(P<0.05);Logistic回归分析显示,SAA、内毒素和SPA水平和PSI评分为重症肺炎患者预后不良的独立影响因素(P<0.05);单一SAA、内毒素、SPA及三者联合预测重症肺炎症患者预后的AUC分别为0.712、0.705、0.764、0.957,三者联合的预测价值更高(P<0.05)。结论 SAA、内毒素、SPA水平与患者病情严重程度均呈正相关性,在重症肺炎预后评估中有重要价值。

Clinical characteristics of community-acquired pneumonia in children caused by mycoplasma pneumoniae with or without myocardial damage:A single-center retrospective study

BACKGROUND Mycoplasma pneumoniae(MP)is a prevalent pathogen that causes respiratory infections in children and adolescents.AIM To assess the differences in the clinical features of MP-associated communityacquired pneumonia(CAP)in children who presented with mild or severe mycoplasma pneumoniae pneumonia(MPP);to identify the incidence of myocardial damage between the two groups.METHODS This work is a retrospective study.We identified children between 2 mo and 16 years of age with clinical and radiological findings consistent with CAP.We admitted patients to the inpatient department of the Second Hospital of Jilin University,Changchun,China,from January 2019 to December 2019.RESULTS A total of 409 hospitalized patients were diagnosed with MPP.Among them were 214(52.3%)males and 195(47.7%)females.The duration of fever and cough was the longest in severe MPP cases.Similarly,plasma levels of highly sensitive Creactive protein(t=-2.834,P<0.05),alanine transaminase(t=-2.511,P<0.05),aspartate aminotransferase(t=-2.939,P<0.05),and lactate dehydrogenase(LDH)(t=-2.939,P<0.05)were all elevated in severe MPP cases compared with mild MPP cases,and these elevations were statistically significant(P<0.05).Conversely,the neutrophil percentage was significantly lower in severe MPP cases than in mild MPP cases.The incidence of myocardial damage was significantly higher in severe MPP cases than in mild MPP cases(χ^(2)=157.078,P<0.05).CONCLUSION Mycoplasma pneumoniae is the main cause of CAP.The incidence of myocardial damage was higher and statistically significant in severe MPP cases than in mild MPP cases.

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance,alveolar capillary injury,pulmonary edema,refractory hypoxemia,and reduced lung compliance.Prolonged hypoxia can cause acid-base balance disorder,peripheral circulatory failure,blood-pressure reduction,arrhythmia,and other adverse consequences.AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure.METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial,with each group comprising 54 patients.The sequential group received invasive and non-invasive sequential mechanical ventilation,whereas the regular group received invasive mechanical ventilation.Blood-gas parameters,hemodynamic parameters,respiratory mechanical parameters,inflammatory factors,and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment.RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24,48,and 72 h of treatment were higher than those of the conventional group(P<0.05).The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group(P<0.05).The pH value of the sequential group at 24 and 72 h of treatment,the central venous pressure value of the treatment at 24 h,and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group(P<0.05).The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group(P<0.05),the measured values of interleukin-6 and tumor necrosis factor-αin the sequential group at 72 h of treatment were lower than those in the conventional group(P<0.05),and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group,with a statistically significant difference(P<0.05).CONCLUSION Treating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance,reducing inflammatory response,maintaining hemodynamic stability,and improving patient blood-gas levels;however,from this study’s perspective,it cannot reduce patient mortality.

MP合并hMPV和SP感染的重症肺炎患儿1例药学监护

临床药师全程参与1例肺炎支原体(MP)合并偏肺病毒(hMPV)和肺炎链球菌(SP)感染的重症肺炎患儿药学监护,在患儿病情复杂、医师忽略MP感染、超说明书用药和违反传统理论联合用药的情况下,查阅资料,结合病情深入剖析,及时提供安全有效的治疗方案分析和建议,监测疗效和不良反应,进行用药指导;较好地保障了患儿用药的安全性和有效性,提供了有效的药学服务,同时为此类患儿的药物治疗和监护提供参考。

Effects of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia

Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to June 2018, 82 patients with severe pneumonia were randomly divided into observation group and control group (all 41 cases). Patients in the control group received conventional anti-infective treatment, and the observation group was treated with fiberoptic bronchoscopy combined with mucosolvan on the basis of the control group. Respiratory function, inflammatory response and stress status were compared between the two groups. Results: Before treatment, there was no significant difference in Cdyn, WOB and PaO2/FiO2 between the two groups. After treatment, Cdyn and PaO2/FiO2 in the observation group were (36.28±4.28) mL/cmH2O and (376.23±24.21) mmHg respectively, while those in the control group were (26.89±3.76) mL/cmH2O and (322.12±23.16) mmHg, respectively. The levels of Cdyn and PaO2/FiO2 in the observation group were higher than those in the control group. After treatment, the WOB in the observation group was (7.81±0.72) J/L, and the WOB in the control group was (8.33±1.23) J/L. WOB of both groups was lower than that before treatment, and in observation group WOB was lower than that of control group, the difference was statistically significant. In CRP, PCT and sTREM-1 levels, there was no significant difference between the two groups before treatment. After treatment, CRP, PCT and sTREM-1 in the observation group were (39.10±6.03) mg/L, (14.57±2.05) ng/L, (15.02±3.02) ng/L respectively, while those in the control group were (59.72±8.81) mg/L, (20.03±3.09) ng/L, (34.21±5.28) ng/L, respectively. CRP, PCT, sTREM-1 in both groups were lower than those before treatment, and CRP, PCT, sTREM-1 in observation group were lower than those in control group. Before treatment, there was no significant difference with Cor, Ang-I and Ang-II in two groups. After treatment, the levels of Cor, Ang-I and Ang-II in the observation group were (114.76±15.85) ng/mL, (6.72±0.64) ng/mL, (27.28±3.43) ng/mL respectively, while those in the control group were (193.15±22.64) ng/mL, (12.10±1.68) ng/mL, (43.02±5.57) ng/mL, respectively. In the observation group, the levels of Cor, Ang-I and Ang-II were lower than those in the control group. Conclusion: Mucosolvan combined with fiberoptic bronchoscopy can effectively improve the respiratory function of patients with severe pneumonia, and reduce inflammation and stress state of the body.

入院时血清PGRN、PCT水平、外周血Caspase-1表达与重症肺炎患儿严重程度的相关性及联合检测对重症肺炎患儿预后的预测价值

目的:探讨入院时血清颗粒蛋白前体(Progranulin,PGRN)、降钙素原(Procalcitonin,PCT)水平、外周血半胱氨酸天冬氨酸蛋白酶1(Caspase-1)表达与重症肺炎患儿严重程度的相关性及联合检测对重症肺炎患儿预后的预测价值。方法:选取2019年10月至2023年10月信阳职业技术学院附属医院收治的153例重症肺炎患儿为研究对象,入院时根据小儿危重病例评分法(Pediatric critical illness score,PCIS)将患儿分为非危重组(62例,80分<PCIS≤100分)、危重组(51例,70分<PCIS≤80分)、极危重组(40例,≤70分),根据28 d预后情况将重症肺炎患儿分为病死(21例)和生存(132例)两个亚组。比较非危重组、危重组、极危重组入院时血清PGRN、PCT水平及外周血Caspase-1表达,分析入院时血清PGRN、PCT水平及外周血Caspase-1表达与重症肺炎患儿严重程度相关性;比较病死患儿、生存患儿入院时血清PGRN、PCT水平及外周血Caspase-1表达;ROC分析入院时血清PGRN、PCT水平及外周血Caspase-1表达联合检测对重症肺炎患儿预后的预测效能。结果:3组入院时血清PGRN、PCT水平及外周血Caspase-1表达比较:非危重组<危重组<极危重组,且均与重症肺炎患儿严重程度呈正相关(P<0.05);病死患儿入院时血清PGRN、PCT水平及外周血Caspase-1表达高于生存患儿(P<0.05);入院时血清Caspase-1、PCT水平及外周血Caspase-1表达联合检测预测重症肺炎患儿病死的AUC、最佳敏感度分别为0.822、95.24%,高于入院时血清PGRN、PCT水平及外周血Caspase-1表达单独检测。结论:入院时血清PGRN、PCT水平及外周血Caspase-1表达检测可评估重症肺炎患儿病情严重程度,且联合检测可预测患儿的死亡情况。临床上可根据入院时血清PGRN、PCT水平及外周血Caspase-1表达早期评估患儿病情,制定针对性治疗干预措施,改善重症肺炎患儿的预后,减少死亡病例的发生。

Effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the SIRS and target organ damage in patients with severe pneumonia complicated by respiratory failure

Objective:To study the effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the systemic inflammatory response syndrome (SIRS) and target organ damage in patients with severe pneumonia complicated by respiratory failure.Methods: A total of 68 patients with severe pneumonia complicated by respiratory failure who received inpatient treatment in our hospital between July 2013 and December 2016 were collected and then divided into the control group (n=35) who received conventional therapy and the observation group (n=33) who received fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol + conventional therapy after the therapies were reviewed. The systemic inflammatory response as well as cardiac and liver function before and after treatment were compared between two groups of patients.Results: Before treatment, differences in serum levels of inflammatory factors, myocardial enzyme spectrum and liver function indexes were not statistically significant between the two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, TNF-α and CRP levels in observation group were lower than those in control group;serum myocardial enzyme spectrum LDH,α-HBDH, CKMB and cTnI levels were lower than those in control group;serum liver function index Alb content was higher than that in control group while ALP, TBA, ALT and AST contents were lower than those in control group.Conclusion:Fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol can effectively reduce the degree of SIRS, and also reduce the cardiac and liver function injury in patients with severe pneumonia complicated by respiratory failure.

Application of 16S rDNA Sequencing Technology in the Analysis of Pathogenic Bacteria in Sputum of Severe Pneumonia

The diagnosis of pathogenic bacteria in severe pneumonia is difficult and the prognosis is poor. Its outcome is closely related to bacterial pathogenicity and the timeliness and pertinence of antibiotic treatment. Therefore, early diagnosis is of great significance to the prognosis of patients. Sputum examination and culture is the gold standard for the diagnosis of pathogens of severe pneumonia. However, due to the long time of bacterial culture, the early use of antibiotics, the change of bacteria species, mixed infection and other problems, the results of bacterial culture in sputum are often false negative. With the continuous application of new molecular biology techniques in clinical detection, the classification of bacteria and microorganisms has deepened from the identification of phenotypic characteristics to the classification of gene characteristics. Sequencing analysis with 16S rDNA sequencing technology has the characteristics of high sequencing flux, large amount of data obtained, short cycle, and can more comprehensively reflect the species composition of microbial community, real species distribution and abundance information. In this paper, 16S rDNA sequencing technology was used to analyze the bacterial population composition in the sputum of severe pneumonia, and to explore a new method of etiological diagnosis.

Application of 16s rDNA Sequencing in the Analysis of Pathogenic Bacteria in Sputum of Severe Bacterial Pneumonia

Objective: 120 patients with severe pneumonia who were kept in the comprehensive ICU of our hospital in 2018 were selected, and 16s rDNA sequencing was performed to analyze the composition of pathogenic bacteria in the sputum of severe pneumonia. Methods: The sputum samples of patients with severe bacterial pneumonia were collected, and the diversity of pathogens in the samples was analyzed by polymerase chain reaction (PCR) amplification and high-throughput sequencing (16s rDNA PCR-DGGE). Results: Sequence showed that sputum samples contained a relatively large number of species, and there were many species that were not detected by sequencing. The dominant bacteria were Streptococcus, Sphingomonas, Corynebacterium, Denatobacteria, Aquobacteria, Acinetobacteria, Prevotella, Klebsiella, Pseudomonas, etc. Conclusion: Bacteria caused by sputum of severe bacterial pneumonia are complex and diverse, which provides new methods and ideas for individualized treatment of patients with severe pneumonia.

肺炎支原体肺炎患儿血清microR-146a、sPD-L2与疾病严重程度及预后的关系研究

目的 研究肺炎支原体肺炎(MPP)患儿血清微小RNA(miR)-146a、可溶性程序性死亡配体2(sPD-L2)水平,分析二者与MPP病情严重程度的关系及对预后的预测价值。方法 选取2019年2月至2021年6月临汾市人民医院收治的89例MPP患儿,根据病情严重程度分为重症组(50例)和轻症组(39例)。根据MPP患儿预后分为预后良好组(70例)和预后不良组(19例)。以同期体检的50例健康儿童为对照组。采用实时荧光定量PCR检测各组血清miR-146a水平。采用酶联免疫吸附试验检测血清sPD-L2水平。采用Pearson相关性分析MPP患儿血清miR-146a与sPD-L2水平的相关性。采用Logistic回归分析影响MPP患儿预后不良的因素。采用受试者工作特征曲线分析血清miR-146a、sPD-L2对MPP患儿预后不良的预测效能。结果 对照组、轻症组及重症组血清miR-146a水平依次降低(P<0.05),而sPD-L2水平依次升高(P<0.05)。MPP患儿血清miR-146a与sPD-L2水平呈负相关(r=-0.735,P<0.001)。预后不良组发热持续时间、胸腔积液比例、C反应蛋白、重症MPP患儿比例及血清sPD-L2水平均高于预后良好组(P<0.05),而血清miR-146a水平低于预后良好组(P<0.05)。重症MPP、血清sPD-L2是MPP患儿预后不良的独立危险因素,miR-146a是保护因素(P<0.05)。血清miR-146a、sPD-L2二者联合预测MPP患儿预后不良的曲线下面积为0.915(95%CI:0.861~0.949),高于miR-146a、sPD-L2单项指标预测的0.844(95%CI:0.801~0.886)和0.859(95%CI:0.814~0.897)(Z=4.780、4.023,均P<0.05)。结论 MPP患儿血清miR-146a水平降低,sPD-L2水平升高,二者与MPP疾病严重程度有关,且二者联合检测对MPP预后不良具有较高的预测价值。

重症肺炎患儿外周血环状RNA circFADS2、circESPL1表达的变化及临床意义

目的研究重症肺炎(SP)患儿外周血环状RNA circFADS2、circESPL1表达的变化及临床意义。方法选择2020年1月至2023年1月期间霍邱县第一人民医院收治的120例SP患儿(SP组)和同期80名健康儿童(对照组)进行研究。检测外周血circFADS2、circESPL1的表达水平。根据肺炎严重程度指数(PSI)将SP患儿分为高危组(PSIⅤ级)、中危组(PSIⅣ级)、低危组(PSIⅠ~Ⅲ级),根据半年预后的随访分为预后良好组和预后不良组。采用logistic回归模型分析SP患儿预后的影响因素,采用ROC曲线分析circFADS2、circESPL1对预后的预测价值。结果SP组外周血circFADS2、circESPL1的表达水平高于对照组,差异有统计学意义(t=10.109、5.181,P<0.05);不同病情严重程度SP患儿外周血circFADS2、circESPL1的表达水平呈现:低危组<中危组<高危组,差异均有统计学意义(F=15.831、11.945,P<0.05);预后不良组SP患儿外周血circFADS2、circESPL1的表达水平高于预后良好组,差异均有统计学意义(t=6.073、3.621,P<0.05);logistic回归分析显示:合并心力衰竭以及外周血circFADS2、circESPL1的表达水平增加是SP患儿预后不良的危险因素(P<0.05);ROC曲线分析显示:外周血circFADS2、circESPL联合检测预测SP患儿预后的灵敏度和特异度分别为84.62%和71.43%,高于单一检测(P<0.05)。结论SP患儿外周血中circFADS2、circESPL1表达增加,两者联合检测对SP预后具有预测价值。

Effects of short-term intensive insulin therapy on systemic inflammatory response and stress response in patients with severe pneumonia

Objective:To study the effects of short-term intensive insulin therapy on systemic inflammatory response and stress response in patients with severe pneumonia.Methods:Patients with severe pneumonia who were treated in our hospital between March 2015 and October 2017 were chosen as the research subjects and randomly divided into the INS group who received short-term intensive insulin combined with routine therapy and the control group who received short-acting insulin combined with routine therapy. The levels of inflammatory factors and stress mediators in serum as well as the expression intensity of inflammatory molecules in peripheral blood were determined before treatment as well as 3 d and 7 d after treatment.Results:Compared with same group before treatment, serum IL-1β, IL-13, suPAR, sTREM1, sP-selectin, SF, 8-iso-PGF2α, AQP1 and AQP5 levels as well as peripheral blood NF-κB, COX2, RANTES, CD28 and CD80 expression intensity of both groups significantly decreased 3 days and 7 days after treatment, and serum IL-1β, IL-13, suPAR, sTREM1, sP-selectin, SF, 8-iso-PGF2α, AQP1 and AQP5 levels as well as peripheral blood NF-κB, COX2, RANTES, CD28 and CD80 expression intensity of INS group 3 d and 7 d after treatment were significantly lower than those of control group.Conclusion: Short-term intensive insulin therapy has inhibitory effect on the systemic inflammatory response and stress response in patients with severe pneumonia.

Correlation of intestinal flora disorder with systemic inflammatory response and stress response in children with severe pneumonia

Objective:To study the correlation of intestinal flora disorder with systemic inflammatory response and stress response in children with severe pneumonia.Methods: The children who were diagnosed with severe pneumonia in Xiangyang No. 1 People's Hospital between April 2014 and December 2017 were selected as the pneumonia group of the study, and the healthy children who received physical examination in Xiangyang No. 1 People's Hospital during the same period were selected as the control group. The feces was collected to determine the number of intestinal flora bifidobacteria and Escherichia coli (E. coli). Besides, the serum was collected to determine the contents of inflammatory cytokines and oxidative stress indexes, and the peripheral blood was collected to determine the expression intensity of inflammatory molecules and oxidative stress molecules.Results:The number of bifidobacteria and the level of Bifidobacterium and E. coli ratio B/E in feces as well as SOD content in serum of pneumonia group were significantly lower than those of control group whereas the number of E. coli in feces, TLR2, TLR4, NOX2, iNOS and FOXP3 expression intensity in peripheral blood as well as G-CSF, sTREM1, TNF-α, LPO and NO contents in serum were significantly higher than those of control group;Pearson correlation analysis showed that B/E level in feces of pneumonia group was negatively correlated with TLR2, TLR4, NOX2, iNOS and FOXP3 expression intensity in peripheral blood as well as G-CSF, sTREM1, TNF-α, LPO and NO contents in serum, and positively correlated with SOD content in serum.Conclusion:The intestinal flora disorder in children with severe pneumonia can aggravate the degree of systemic inflammatory response and stress response in the course of disease.