摘要
目的 探讨呼吸道假丝酵母定植对儿童细菌性呼吸机相关性肺炎(VAP)及丝氨酸-苏氨酸蛋白酶/核转录因子-κB(Akt/NF-κB)信号通路的影响。方法 选取2018年10月-2021年11月中国医科大学附属盛京医院120例机械通气患儿,其中发生儿童细菌性VAP患儿65例纳入VAP组(呼吸道假丝酵母定植39例),未发生VAP患儿55例纳入对照组(呼吸道假丝酵母定植19例)。通过Logistic回归分析儿童细菌性呼吸机相关性肺炎发生的危险因素,检测研究对象外周血Akt mRNA、NF-κB mRNA表达水平,分析其与VAP的发生以及呼吸道假丝酵母定植的关系。结果 65例儿童细菌性VAP患儿共分离出病原菌107株,其中革兰阴性菌97株占90.65%,革兰阳性菌10株占9.35%;机械通气时间、再插管、意识障碍、呼吸道假丝酵母定植是儿童细菌性VAP发生的影响因素(P<0.05);65例细菌性VAP患儿,定植组与未定植组28 d病死率差异无统计学意义(P=0.645);细菌性VAP患儿外周血Akt mRNA、NF-κB mRNA水平高于对照组(P<0.05);外周血Akt mRNA、NF-κB mRNA联合检测评估儿童细菌性VAP发生受试者工作特征(ROC)曲线下面积为0.881,高于两项指标单独检测曲线下面积0.797、0.790(P<0.05);VAP组、对照组呼吸道假丝酵母定植与未定植患儿外周血Akt mRNA、NF-κB mRNA差异无统计学意义。结论 呼吸道假丝酵母定植增加机械通气患儿细菌性VAP发生风险,VAP发生后外周血p-Akt mRNA、NF-κB mRNA呈现高表达,Akt/NF-κB信号通路激活介导VAP发生发展,但呼吸道假丝酵母定植与Akt/NF-κB信号通路激活无明显关系。
OBJECTIVE To investigate the effects of respiratory Candida colonization on bacterial ventilator-associated pneumonia(VAP) and serine-threonine protease/nuclear factor-κB(Akt/NF-κB) signaling pathways in children.METHODS A total of 120 children undergoing mechanical ventilation in Shengjing Hospital Affiliated to China Medical University between Oct.2018 and Nov.2021 were selected,of which 65 cases with childhood bacterial VAP were included in VAP group(39 cases of respiratory Candida colonization) and 55 cases without VAP were included in control group(19 cases of respiratory Candida colonization).Logistic regression was used to analyze the risk factors of bacterial VAP in children,and the expression levels of Akt mRNA and NF-κB mRNA in peripheral blood of the study subjects were detected,and their relationship with the occurrence of VAP and respiratory Candida colonization in the respiratory tract was analyzed.RESULTS A total of 107 strains of pathogenic bacteria were isolated from 65 children with bacterial VAP,of which 97 strains of Gram-negative bacteria accounted for 90.65%,and 10 strains of Gram-positive bacteria accounted for 9.35%.Duration of mechanical ventilation,reintubation,impaired consciousness,and respiratory Candida colonization were influencing factors of bacterial VAP in children(P<0.05).Among the 65 children with bacterial VAP,there was no significant difference in the 28d mortality rate between the colonization group and non-colonization group(P=0.645).The expression of peripheral blood Akt mRNA and NF-κB mRNA in children with bacterial VAP were higher than those in control group(P<0.05).The area under the ROC curve(AUC) of Akt mRNA combined with NF-κB mRNA for evaluating the occurrence of bacterial VAP in children was 0.881,greater than that of the two indicators alone(0.797 and 0.790,respectively)(P<0.05).There was no significant difference in the peripheral blood Akt mRNA and NF-κB mRNA between children with or without respiratory Candida colonization in the VAP group and control gro
作者
冯园园
刘伟
冯蕊
王静
吴邹玉
FENG Yuan-yuan;LIU Wei;FENG Rui;WANG Jing;WU Zou-yu(Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110000,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第3期476-480,共5页
Chinese Journal of Nosocomiology
基金
辽宁省科研基金资助项目(2020G02141)。
