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发布时间：2022-04-08 11:40:12

呼吸机相关肺炎患者病原菌分布及血清miR⁃146a、 miR⁃155的检测分析 

王宏伟，宋晓萍，裴复阳 （大连大学附属中山医院呼吸科，辽宁 大连 116001） 摘要：目的 探讨呼吸机相关肺炎（VAP）患者病原菌分布及血清微小 RNA⁃146a（miR⁃146a）、miR⁃155 表达水平及 临床意义。方法 选择 2018 年 12 月-2021 年 4 月在大连大学附属中山医院进行机械通气治疗的患者 197 例作为 观察对象，其中符合 VAP 诊断标准的 107 例患者作为 VAP 组，未感染患者 90 例作为非 VAP 组，另选择同期健康体 检人员 100 人作为对照组。采用实时荧光定量 PCR 法（RT⁃qPCR）检测血清 miR⁃146a、miR⁃155 表达，采用 ELISA 方 法检测血清 C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF⁃α）水平，Pearson 法分析 miR⁃146a、miR⁃155 与 CRP、TNF⁃α 相关性，ROC 曲线分析 miR⁃146a、miR⁃155 对 VAP 的诊断价值。结果 107 例 VAP 患者共分离出 170 株致病菌，以 革兰阴性菌为主共 91 株占 53.53%，其次是革兰阳性菌 73 株占 42.94%，真菌 6 株（3.53%）。革兰阴性菌以铜绿假单 胞菌为主，革兰阳性菌以金黄色葡萄球菌为主。与对照组比较，非 VAP 组、VAP 组患者血清 miR⁃146a、miR⁃155 及 CRP、TNF⁃α 表达水平显著升高，差异有统计学意义（P<0.05）；与非 VAP 组比较，VAP 组患者血清 miR⁃146a、miR⁃ 155 及 CRP、TNF⁃α 表达水平显著升高，差异有统计学意义（P<0.05）。相关性分析显示，VAP 患者血清 miR⁃146a、 miR⁃155 表达水平均与 CRP、TNF⁃α 水平呈正相关（P<0.05）。miR⁃146a、miR⁃155 联合诊断 VAP 的灵敏度为 87.57%， 特异度为92.44%，曲线下面积为0.920。结论 VAP 患者以革兰阴性菌为主要致病菌，血清miR⁃146a、miR⁃155 表达 水平升高，二者联合检测对 VAP 有一定诊断价值。 关键词：微小 RNA⁃146a；微小 RNA⁃155；呼吸机相关肺炎；病原菌 中图分类号：R563.1 文献标识码：A 文章编号：1672⁃3619（2022）01⁃0037⁃04 

Distribution of pathogenic bacteria and detection and analysis of serum miR⁃146a and miR⁃155 in patients with ventilator⁃associated pneumonia 

WANG Hong⁃wei，SONG Xiao⁃ping，PEI Fu⁃yang （Department of Respiratory Medicine，Zhongshan Hospital，Dalian University，Dalian，Liaoning 116001，China） Corresponding author：WANG Hong⁃wei，E⁃mail：whw13591172837@163.com Abstract：Objective To investigate the distribution of pathogenic bacteria and serum miR⁃146a and miR⁃155 expression levels and clinical significance in patients with ventilator⁃associated pneumonia（VAP）. Methods A total of 197 patients who were treated in Zhongshan Hospital Affiliated to Dalian University from December 2018 to April 2021 were selected as observation objects. Among them，107 patients meeting the diagnostic criteria of VAP were regarded as the VAP group，and 90 patients without infection were regarded as the non⁃VAP group. In addition，100 health examiners during the same period were selected as the control group. Real⁃time fluorescent quantitative PCR（RT⁃qPCR）was used to detect the expression of serum miR⁃146a and miR⁃155；ELISA method was used to detect the levels of serum C⁃reaction protein（CRP）and tumor necrosis factor⁃α（TNF⁃α）. Pearson method was used to analyze the correlation between miR⁃146a，miR⁃155 and CRP，TNF⁃ α，and ROC curve was used to analyze the diagnostic value of miR⁃146a and miR⁃155 for VAP. Results A total of 170 pathogenic bacteria were isolated from 107 patients. Among them，91 were Gram⁃negative bacteria，accounting for 53.53%， mainly Pseudomonas aeruginosa；73 were Gram⁃positive bacteria，accounting for 42.94%，mainly Staphylococcus aureus；6 were fungi，accounting for 3.53%.Compared with the control group，the levels of serum miR⁃146a，miR⁃155，CRP and TNF⁃ α in the non ⁃VAP group and VAP group were significantly increased，and the difference was statistically significant（P< 0.05）；compared with the non⁃VAP group，the levels of serum miR⁃146a，miR⁃155，CRP and TNF⁃α in the VAP group were significantly increased，and the difference was statistically significant（P<0.05）；correlation analysis showed that the ·实验研究论著· DOI：10.3969/j.issn.1672⁃3619.2022.01.008 · 37 ·热带医学杂志 2022 年 1 月第 22 卷第 1 期 J Trop Med，Jan. 2022，Vol.22，No.1 expression levels of serum miR⁃146a and miR⁃155 in VAP patients were positively correlated with CRP and TNF⁃ α levels （P<0.05）；the sensitivity of miR⁃146a combined with miR⁃155 in the diagnosis of VAP was 87.57%，the specificity was 92.44%，and the area under the curve was 0.920. Conclusions Gram⁃negative bacteria were the main pathogens in VAP patients，and serum miR ⁃ 146a and miR ⁃ 155 expression levels were elevated. The combined detection of the two had a certain diagnostic value for VAP. Keywords：microRNA⁃146a；microRNA⁃155；Ventilator⁃associated pneumonia；Pathogenic bacteria

呼吸机相关肺炎患者病原菌分...、miR-155的检测分析_王宏伟.pdf