摘要
目的探讨急性脑梗死合并肺部感染(PI)患者病原菌耐药特点及血清微小核糖核酸-5787(miR-5787)、微小核糖核酸-133(miR-133)、B淋巴细胞瘤-2相关X蛋白(Bax)、B淋巴细胞瘤-2(Bcl-2)表达水平。方法选取2021年1月-2023年8月峨眉山市人民医院收治的82例急性脑梗死合并PI患者作为A组,另选取同期收治的90例急性脑梗死无PI患者作为B组;分析A组患者病原菌分布特点及耐药性,比较两组血清miR-5787、miR-133、Bax、Bcl-2表达水平、红细胞免疫参数及炎性因子水平,并采用Pearson相关性分析血清miR-5787、miR-133、Bax、Bcl-2与红细胞免疫参数、炎性因子的相关性。结果82例急性脑梗死合并PI患者共分离出132株病原菌株,革兰阳性菌的占比为34.85%,主要为金黄色葡萄球菌,革兰阴性菌的占比为61.36%,主要为肺炎克雷伯菌,真菌的占比为3.79%;肺炎克雷伯菌对克林霉素、环丙沙星及磺胺甲噁唑/甲氧苄啶的耐药性较高,耐药率均为55.17%;金黄色葡萄球菌对阿莫西林、氨苄西林、青霉素、头孢他啶、环丙沙星的耐药性较高;与B组比较,A组血清miR-5787、miR-133、Bax水平均更高,血清Bcl-2水平更低(P<0.05);A组全血免疫黏附抑制因子(FEIR)及血清白细胞介素(IL)-17、肿瘤坏死因子-α(TNF-α)水平高于B组,全血协同肿瘤红细胞花环率(ATER)、自然肿瘤红细胞花环率(NTER)及血清IL-10水平低于B组(P<0.05);血清miR-5787、miR-133、Bax与全血FEIR、血清IL-17、TNF-α水平呈正相关,与全血ATER、NTER及血清IL-10水平呈负相关;血清Bcl-2与全血FEIR、血清IL-17、TNF-α水平呈负相关,与全血ATER、NTER及血清IL-10水平呈正相关(P<0.05)。结论急性脑梗死合并PI病原菌中占比较高的为肺炎克雷伯菌,且PI会导致患者机体促炎/抗炎机制失衡,抑制红细胞免疫功能,且血清miR-5787、miR-133、Bax、Bcl-2表达变化与患者红细胞免疫及炎症指标密切相关。
OBJECTIVE To explore the drug resistance of pathogenic bacteria in patients with acute cerebral infarc-tion and pulmonary infection(PI),and to analyze the expression levels of serum microRNA-5787(miR-5787),microRNA-133(miR-133),B-lymphomatoma-2 related X protein(Bax),and B-lymphomatoma-2(Bcl-2).METHODS A total of 82 patients with acute cerebral infarction combined with pulmonary infection admitted to the People's Hospital of Emeishan from Jan 2021 to Aug 2023 were recruited as the group A,and 90 patients with a-cute cerebral infarction without pulmonary infection during the same period were enrolled in the group B.The dis-tribution and drug resistance of pathogenic bacteria in the group A were analyzed.The expression levels of serum miR-5787,miR-133,Bax,Bcl-2,red blood cell immune parameters and levels of inflammatory factor between the two groups were compared.The correlation of serum levels of miR-5787,miR-133,Bax and Bcl-2 with red blood cell immune parameters and inflammatory factors were analyzed by Pearson correlation analysis.RESULTS A total of 132 pathogenic strains were isolated from 82 patients with acute cerebral infarction combined with PI.Gram-positive bacteria accounted for 34.85%,mainly Staphylococcus aureus.Gram-negative bacteria accounted for 61.36%,mainly Klebsiella pneumoniae,and fungi accounted for 3.79%.Klebsiella pneumoniae had high drug resistance to clindamycin,ciprofloxacin,and sulfamethoxazole/trimethoprim,with the drug-resistant rates of 55.17%;S.aureus had high drug resistance to amoxicillin,ampicillin,penicillin,ceftazidime,and ciprofloxacin.Compared with the group B,the levels of serum miR-5787,miR-133,and Bax in the group A were higher while the levels of serum Bcl-2 were lower(P<0.05).The levels of whole blood immune adhesion inhibitory factor(FEIR),serum interleukin-17(1L-17),and tumor necrosis factor a(TNF-α)in the group A were higher than those in the group B.The levels of whole blood synergistic tumor red blood cell rosette rate(ATER),natural tumor red blood cell rosette rate(
作者
梁晶晶
谭熙
LIANG Jing-jing;TAN Xi(Emeishan People's Hospital,Mount Emei,Sichuan 614200,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2024年第15期2253-2258,共6页
Chinese Journal of Nosocomiology
基金
2022年四川省抗癌协会肿瘤临床科研项目(XH2022-106)。
