非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎病原菌组成及耐药性分析

目的分析非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎临床特征、病原菌组成及耐药性,指导临床诊断及合理使用抗菌素。方法回顾性分析46例前瞻性观察诊断的非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎临床及微生物学资料。结果平均起病时间为人院后（14．3±13．2）d,最常见基础疾病依次为脑血管意外（16／46）,慢性肺部疾病（13／46）和糖尿病（5／46）。培养阳性率58．7％,最常见细菌依次为鲍曼不动杆菌（8／27）、铜绿假单胞菌（6／27）、阴沟肠杆菌（3／29）及金黄色葡萄球菌（3／29）。80．4％患者入院72h内使用过抗生素,初始经验性治疗最常使用的抗菌素依次为头孢菌素（29／46）、碳青霉烯类（9／46）、糖肽类（5／46）。8株鲍曼不动杆菌对头孢哌酮／舒巴坦中介MIC〉32mg／L,对其他抗生素耐药;2株铜绿假单胞菌对美罗培南高度耐药MIC=128mg／L。结论非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎多发生在有脑血管疾病及慢性肺疾病老年患者,我院非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎最常见的病原菌多药耐药鲍曼不动杆菌,铜绿假单胞菌对碳青霉烯类耐药率较高。应优化医院获得性肺炎及呼吸机相关肺炎初始抗生素使用。     

难治性肺炎支原体肺炎患儿血清炎性细胞因子变化的临床意义及其危险因素分析

目的:探讨难治性肺炎支原体肺炎(RMPP)患儿血清炎性细胞因子变化的临床意义及其危险因素。方法:将我院从2016年1月～2020年1月收治的72例RMPP患儿纳入研究,记作RMPP组。另取我院同期收治的普通肺炎支原体肺炎(MPP)患儿70例作为对照组。检测所有患儿的血清炎性细胞因子水平,并进行对比。此外,对比两组患儿各项基线资料,并以多因素Logistic回归分析RMPP发生的危险因素。另外,比较两组患儿的影像学特征。结果:RMPP组患儿血清白细胞介素-6(IL-6)以及白细胞介素-10(IL-10)水平均高于对照组(P0.05);而两组肿瘤坏死因子-α(TNF-α)水平对比差异不明显(P0.05)。RMPP组年龄、发热持续时间、发热峰值、住院时间以及发热伴随症状人数占比均高于对照组(P0.05)。经多因素Logistic回归分析发现:发热持续时间、发热峰值、住院时间以及发热伴随症状均是RMPP患儿发病的危险因素(OR=2.773、2.344、1.058、2.515,均P0.05)。RMPP组大叶性肺炎、胸腔积液人数占比均高于对照组,而支气管肺炎人数占比低于对照组(P0.05)。结论:RMPP患儿血清IL-6以及IL-10水平均存在明显高表达,且发热持续时间、发热峰值、住院时间以及发热伴随症状均是RMPP发病的危险因素,临床工作中需要予以重视。     

阿奇霉素治疗小儿支原体肺炎的效果观察和安全性分析

目的观察大环内酯类抗生素阿奇霉素治疗小儿支原体肺炎的临床疗效,并对用药安全性进行评价。方法选择我院2012年6月至2014年10月呼吸科收治的96例小儿支原体肺炎患者,随机平均分为观察组和对照组。观察组给予阿奇霉素治疗,对照组给予红霉素治疗,观察两组的临床疗效和不良反应。结果观察组患者治愈37例,显效8例,无效3例,总有效率为93.75%;对照组治愈30例,显效9例,无效9例,总有效率为81.25%,治疗组疗效优于对照组,差异有统计学意义(P0.05)。治疗组患者平均退热、止咳、平喘、肺部啰音消失时间均短于对照组,平均住院时间和住院花费均少于对照组,差异有统计学意义(P0.05)。两组均偶见局部皮疹、注射部分疼痛等轻度不良反应,差异无统计学意义;观察组无胃肠道反应,对照组有4例胃肠道反应。结论阿奇霉素治疗小儿支原体肺炎能有效改善临床症状,较红霉素能提高治疗效果,缩短病程,且无严重不良反应,安全可靠,值得推广应用。     

注射用阿齐霉素治疗儿童肺炎的疗效及安全性观察

目的　探讨注射用阿齐霉素治疗儿童细菌性肺炎的疗效及安全性。方法　2 0 0 3年1月～2 0 0 3年9月,应用注射用阿齐霉素治疗10 0例细菌性肺炎患者,阿齐霉素剂量按10 mg/ ( kg·d)加入葡萄糖溶液,每天1次静滴,疗程5～7d,观察治疗前后症状体征的变化以及外周血象、肝肾功能及X线胸片变化,并取咽部或上呼吸道分泌物做细菌培养及阿齐霉素药敏试验。结果　注射用阿齐霉素临床总有效率为93.0 % ,不良反应发生率为11.0 % ,不良反应症状轻微。结论　注射用阿齐霉素治疗儿童细菌性肺炎疗效满意,安全性高     

血清LTB4和PCT在细菌性肺炎患者中的表达及其与预后的相关性

目的探究治疗前后细菌性肺炎患者血清中白三烯B4(LTB4)、降钙素原(PCT)表达水平及其与预后相关性。方法选取2018年3月-2019年2月我院收治细菌性肺炎患者作为观察组(n=70),另选择同期于我院体检健康合格者作为对照组(n=70)。观察两组血清LTB4、PCT表达水平。观察治疗1周后、治疗2周后观察组患者血清LTB4、PCT表达水平。采用ROC曲线及Cox分析法分析观察组血清LTB4、PCT表达水平与预后相关性。结果观察组治疗前LTB4与PCT水平均高于对照组(P<0.05)。治疗1周及治疗2周后观察组LTB4、PCT水平均低于治疗前(P<0.05);治疗2周后LTB4、PCT水平分别低于治疗1周后(P<0.05)。治疗后PCT、LTB4的AUC均较高(P<0.05)。PCT与LTB4与观察组患者预后均具有独立相关性(P<0.05)。结论血清PCT与LTB4在细菌性肺炎患者中处于高表达状态,治疗后两者表达水平显著降低。血清PCT及LTB4与患者预后情况密切相关,可作为临床监测细菌性肺炎患者预后重要指标。     

131 例住院肺炎患儿细菌感染现况及耐药谱分析

目的:分析住院肺炎患儿的病原菌分布及其耐药性。方法:选择2009年6月至2010年5月,新疆维吾尔自治区人民医院儿科住院的791例肺炎患儿,采取下呼吸道痰液标本,进行细菌培养及药敏试验。结果:16.56%(131/791)患儿被确诊为细菌性肺炎并且有明确的病原,其中,革兰阴性菌感染为75.57%(99/131),且以肺炎克雷伯氏菌、大肠埃希菌、阴沟肠杆菌多见;革兰阳性菌感染为21.37%(28/131),以肺炎链球菌多见;真菌感染为6.87%(9/131),均为白色假丝酵母;9.92%(13/131)的患儿存在两种及以两种上病原菌感染。鲍曼不动杆菌和肠杆菌对头孢类抗生素耐药严重,部分肺炎克雷伯菌、大肠埃希菌产β-内酰胺酶(BLA),葡萄球菌属耐青霉素G,肠球菌对氯洁霉素、红霉素和复方新诺明耐药率100%,而肺炎链球菌对红霉素耐药率100%。真菌对常用抗菌药的耐药率为0。结论:我院住院肺炎患儿细菌性为16.56%。病原菌构成以革兰阴性菌为主,并且大多数病原菌耐药。临床应根据痰液细菌培养和药敏结果,合理选择抗菌药物,以减少细菌耐药性,防止滥用抗生素。     

131例住院肺炎患儿细菌感染现况及耐药谱分析

目的：分析住院肺炎惠儿的病原菌分布及其耐药性。方法：选择2009年6月至2010年5月,新疆维吾尔自治区人民医院儿科住院的791例肺炎患儿,采取下呼吸道痰液标本,进行细菌培养及药敏试验。结果：16．56％（131／791）患儿被确诊为细菌性肺炎并且有明确的病原,其中,革兰阴性菌感染为75．57％（99／131）,且以肺炎克雷伯氏菌、大肠埃希菌、阴沟肠杆菌多见;革兰阳性菌感染为21．37％（28／131）,以肺炎链球菌多见;真菌感染为6．87％（9／131）,均为白色假丝酵母;9．92％（13／131）的患儿存在两种及以两种上病原菌感染。鲍曼不动杆菌和肠杆菌对头孢类抗生素耐药严重,部分肺炎克雷伯菌、大肠埃希菌产伊内酰胺酶（BLA）,葡萄球菌属耐青霉素G,肠球菌对氯洁霉素、红霉素和复方新诺明耐药率100％,而肺炎链球菌对红霉素耐药率100％。真菌对常用抗菌药的耐药率为0。结论：我院住院肺炎患儿细菌性为16．56％。病原菌构成以革兰阴性菌为主,并且大多数病原菌耐药。临床应根据痰液细菌培养和药敏结果,合理选择抗菌药物,以减少细菌耐药性,防止滥用抗生素。     

Antibacterial activity of hinokitiol against both antibiotic‐resistant and ‐susceptible pathogenic bacteria that predominate in the oral cavity and upper airways

Hinokitiol, a component of the essential oil isolated from Cupressaceae, possesses antibacterial and antifungal activities and has been used in oral care products. In this study, the antibacterial activities of hinokitiol toward various oral, nasal and nasopharyngeal pathogenic bacteria, including Streptococcus mutans, Streptococcus sobrinus, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Fusobacterium nucleatum, methicillin‐resistant and ‐susceptible Staphylococcus aureus, antibiotic‐resistant and ‐susceptible Streptococcus pneumoniae, and Streptococcus pyogenes were examined. Growth of all these bacterial strains was significantly inhibited by hinokitiol, minimal inhibitory concentrations of hinokitiol against S. mutans, S. sobrinus, P. gingivalis, P. intermedia, A. actinomycetemcomitans, F. nucleatum, methicillin‐resistant S. aureus, methicillin‐susceptible S. aureus, antibiotic‐resistant S. pneumoniae isolates, antibiotic‐susceptible S. pneumoniae, and S. pyogenes being 0.3, 1.0, 1.0, 30, 0.5, 50, 50, 30, 0.3–1.0, 0.5, and 0.3 μg/mL, respectively. Additionally, with the exception of P. gingivalis, hinokitiol exerted bactericidal effects against all bacterial strains 1 hr after exposure. Hinokitiol did not display any significant cytotoxicity toward the human gingival epithelial cell line Ca9‐22, pharyngeal epithelial cell line Detroit 562, human umbilical vein endothelial cells, or human gingival fibroblasts, with the exception of treatment with 500 μg/mL hinokitiol, which decreased numbers of viable Ca9‐22 cells and gingival fibroblasts by 13% and 12%, respectively. These results suggest that hinokitiol exhibits antibacterial activity against a broad spectrum of pathogenic bacteria and has low cytotoxicity towards human epithelial cells.     

儿童社区获得性支原体肺炎病原学与影像学特征分析

目的:回顾性分析我院儿童社区获得性肺炎(Community-acquired pneumonia,CAP)患儿病原学检测结果,为本地区CAP患儿的临床治疗提供参考依据。方法:选取2014年5月-2018年5月812例符合中华医学会儿科学分会制定的儿童社区获得性肺炎(2013修订)诊断标准的CAP患儿,分析患儿的临床特征及影像学检查结果,并进行分析。结果:非重症CAP患儿812例,CAP占10.2%;感染病原体例数481例,阳性检出率为59.2%;1月-1岁龄组与1-5岁龄组比较差异无统计学意义(P0.05);5-14岁龄组发热发生率明显高于前两组,差异均有统计学意义(P0.05)。咳嗽、喘息、固定湿啰音发生率集中在1月-1岁龄组与1-5岁龄组,且高于5-14岁龄组发生率(P0.0);肺部影像学改变的患儿共657例,占80.9%。三个年龄组;肺部影像学改变差异有统计学意义(P0.05)。结论:不同年龄段CAP患儿病原体检出率不同;不同年龄和不同病原学感染的儿童CAP的影像学表现各有特点,对于临床医生早发现、早诊断、早治疗具有一点的指导性意义。     

肺炎支原体P1重组蛋白的提取纯化及应用研究

提取纯化肺炎支原体(Mycoplasma pneumoniae,Mp)P1重组蛋白,建立酶联免疫吸附实验(ELISA)的方法,协助临床肺炎支原体感染的诊断。以GST融合蛋白层析柱提取、纯化Mp P1重组蛋白做抗原,以全肺炎支原体菌体成分做抗原对照,建立间接ELISA实验方法,检测40份正常献血者血清标本和51份疑似MP感染临床血清标本的IgG抗体。重组蛋白经SDS-PAGE可见诱导表达的样品在分子量大约59 ku处有明显条带,经Western blotting可与肺炎支原体免疫血清发生反应。ELISA实验检测51份临床标本,由P1重组蛋白抗原检测阳性31份,阳性率为60.78%。Mp检测阳性20份,阳性率为39.22%。实验精确度检测阳性混合血清的变异系数(CV值)为5.40%,阴性混合血清变异系数为1.10%。用Mp P1重组蛋白抗原建立的ELISA检测方法,其敏感性高于全肺炎支原体抗原,可用于临床肺炎支原体感染的诊断。     

四川绵阳地区肺炎链球菌流行病学特征

目的了解四川绵阳地区肺炎链球菌的耐药情况,为临床合理用药及感染控制提供依据。方法收集我院2015年1月至2017年12月临床分离的718株肺炎链球菌,并对其药物敏感性检测结果进行分析。结果肺炎链球菌对红霉素和四环素的耐药率最高,均在95%以上;对左氧氟沙星、莫西沙星、泰利霉素、氯霉素的敏感性较高,均在89%以上;对青霉素、美罗培南、阿莫西林和头孢类抗生素的耐药率均在30%以上;未检出万古霉素和利奈唑胺耐药株。肺炎链球菌主要耐药模式为头孢曲松+红霉素+四环素+复方新诺明+美罗培南+青霉素+阿莫西林+头孢噻肟,占19.44%。2017年肺炎链球菌青霉素敏感株和不敏感菌株对美罗培南、阿莫西林、厄他培南、头孢噻肟、头孢曲松、氧氟沙星、复方新诺明和氯霉素的不敏感率比较差异有统计学意义(P0.05)。结论本地区肺炎链球菌对红霉素、四环素耐药率较高,不适用于肺炎链球菌感染的治疗;对青霉素、美罗培南、阿莫西林和头孢类抗生素不敏感率较高,应慎重用于经验治疗;对万古霉素、利奈唑胺和喹诺酮类药物敏感性较高,临床可合理使用。     

Lung inflammatory pattern and antibiotic treatment in pneumonia

Background

In community-acquired pneumonia host inflammatory response against the causative microorganism is necessary for infection resolution. However an excessive response can have deleterious effects. In addition to antimicrobial effects, macrolide antibiotics are known to possess immunomodulatory properties.We aimed to evaluate inflammatory cytokine profiles – both locally (bronchoalveolar lavage) and systemically (blood) – in community-acquired pneumonia admitted patients after at least 72 hours of antibiotic treatment (with and without macrolide containing regimens) and requiring bronchoscopic examination for inadequate response due to infection progression and/or lack of clinical stability.

Methods

A prospective study was performed on 52 admitted patients who developed an inadequate response after 72 hours of antibiotic treatment - non-responders community-acquired pneumonia - (blood and bronchoalveolar lavage), and two control groups: 1) community-acquired pneumonia control (blood) and 2) non-infection control (blood and bronchoalveolar lavage). Cytokine profiles (interleukin (IL)-6, IL-8, IL-10), tumour necrosis factor α and clinical outcomes were assessed.

Results

Non–responders patients treated with macrolide containing regimens showed significantly lower levels of IL-6 and TNF-α in bronchoalveolar lavage fluid and lower IL-8 and IL-10 in blood than those patients treated with non-macrolide regimens. Clinical outcomes showed that patients treated with macrolide regimens required fewer days to reach clinical stability (p < 0.01) and shorter hospitalization periods (p < 0.01).

Conclusions

After 72 hours of antibiotic effect, patients who received macrolide containing regimens exhibited lower inflammatory cytokine levels in pulmonary and systemic compartments along with faster stabilization of infectious parameters.     

酚妥拉明联合多巴酚丁胺与多巴胺治疗重症肺炎患儿的有效性及安全性分析

目的:分析和比较酚妥拉明联合多巴酚丁胺与多巴胺治疗重症肺炎患儿的有效性及安全性。方法:选取2014年4月至2019年4月西安交通大学附属儿童医院急诊科收治的96例重症肺炎患儿,根据入院单双号将其分为对照组(n=48)和研究组(n=48)。对照组接受多巴酚丁胺与小剂量多巴胺治疗,研究组在对照组的基础上联合酚妥拉明治疗。比较两组的治疗总有效率、治疗前后各血气指标与炎性因子水平变化以及不良反应的发生情况。结果:治疗后,研究组总有效率显著高于对照组(93.75%vs.79.17%,P0.05);两组的血气指标PaO2、SaO2均显著升高,PaCO2显著降低,且研究组的变化比对照更加显著(P0.05);两组各的炎性因子水平IL-6、IL-8、CRP和TNF-α均显著降低,且研究组显著低于对照组(P0.05)。两组不良反应发生率比较无统计学差异(P0.05)。结论:酚妥拉明联合多巴酚丁胺治疗重症肺炎患儿的临床疗效明显优于酚妥拉明联合多巴胺治疗,且二者安全性相当。     

Immunogenicity and protective efficacy of GroEL (hsp60) of Streptococcus pneumoniae against lethal infection in mice

The present study was carried out to evaluate the immunogenicity and protective efficacy of GroEL (hsp60) of Streptococcus pneumoniae , by expressing full length GroEL in heterologous host Escherichia coli BL21(DE3). PCR-amplified groEL was ligated in pQE 30 expression vector and subsequently transformed in E. coli DH5α strains. Cloning of groEL was confirmed by double digestion, followed by DNA sequencing. The His-tag containing recombinant GroEL was purified by Ni-NTA affinity chromatography. To determine the immunogenicity of GroEL, the mice were immunized by injecting 40 μg GroEL protein per mouse intraperitoneally. The results showed a significant increase in antibody titre and lymphocyte proliferation in animals immunized with GroEL as compared with control. Further, there was an appreciable increase in interleukin-2 (IL-2) and IL-4 production in lymphocytes isolated from immunized mice as compared with control. To determine the efficacy of GroEL in eliciting protection, the mice were challenged with the lethal dose of S. pneumoniae A66 type 3 capsular strain intranasally after the seventh day of the last immunization. In the GroEL-immunized mice the onset of death was insignificantly delayed and all the mice died by the seventh day postinfection.     

早期肠内营养和肠外营养对ICU中重症肺炎患者预后的影响

目的:研究早期肠内和肠外营养对ICU中重症肺炎患者预后的影响。方法:选取2013年1月-2014年1月我院重症医学科60例重症肺炎患者随机分为肠内营养组30例(enteral nutrition,EN组)和完全肠外营养支持组30例(total parenteral nutrition,TPN组),经过营养支持治疗后,将两组的免疫、营养以及有创机械通气的时间等指标进行比较。结果:肠内营养组与肠外营养组对比发现,在第5天、第10天EN组血清免疫球蛋白和T细胞亚群细胞数显著升高(P0.05);血红蛋白(HGB)、白蛋白(ALB)和血清前白蛋白(PAB)明显升高(P0.05);有创机械通气时间缩短(P0.05),差异具有统计学意义。结论:ICU中重症肺炎应选择肠内营养支持方式,肠内营养能有效的改善营养状态,并能改善患者的免疫功能,减少有创机械通气时间。     

Expression of HSP47 in Usual Interstitial Pneumonia and Nonspecific Interstitial Pneumonia

Background

Heat shock protein (HSP) 47, a collagen-specific molecular chaperone, is involved in the processing and/or secretion of procollagens, and its expression is increased in various fibrotic diseases. The aim of this study was to determine whether quantitative immunohistochemical evaluation of the expression levels of HSP47, type I procollagen and α-smooth muscle actin (SMA) allows the differentiation of idiopathic usual interstitial pneumonia (UIP) from UIP associated with collagen vascular disease (CVD) and idiopathic nonspecific interstitial pneumonia (NSIP).

Methods

We reviewed surgical lung biopsy specimens of 19 patients with idiopathic UIP, 7 with CVD-associated UIP and 16 with idiopathic NSIP and assigned a score for the expression of HSP47, type I procollagen and α-SMA in type II pneumocytes and/or lung fibroblasts (score 0 = no; 1 = weak; 2 = moderate; 3 = strong staining).

Results

The expression level of HSP47 in type II pneumocytes of idiopathic UIP was significantly higher than in CVD-associated UIP and idiopathic NSIP. The expression of HSP47 in fibroblasts was significantly higher in idiopathic UIP and idiopathic NSIP than in CVD-associated UIP. The expression of type I procollagen in type II pneumocytes was significantly higher in idiopathic UIP than in idiopathic NSIP. The expression of type I procollagen in fibroblasts was not different in the three groups, while the expression of α-SMA in fibroblasts was significantly higher in idiopathic UIP than in idiopathic NSIP.

Conclusion

Our results suggest the existence of different fibrotic pathways among these groups involved in the expression of HSP47 and type I procollagen.     

SARS及其病原体研究进展

严重急性呼吸道综合症(SARS)的病原体己被认定为一种新的冠状病毒-SARS冠状病毒。关于SARS冠状病毒的基因组和蛋白组研究也已取得重要进展,这为探索SARS病毒的来源与进化、研制SARS诊断试剂、开发SARS疫苗和治疗药物奠定了坚实基础。本文对严重急性呼吸道综合症病原学研究取得的一些进展进行了综述。     

住院肺炎患儿偏肺病毒和呼吸道合胞病毒感染研究

为探讨沈阳地区肺炎患儿中偏肺病毒(hMPV)和呼吸道合胞病毒(RSV)感染情况,用反转录聚合酶链反应(RT-PCR)法对部分因肺部感染住院患儿进行了病原学研究。结果显示,hMPV感染率为9%;而RSV感染率为46%,其中A型占40%,B型占60%。研究结果表明,在婴幼儿肺炎患儿中RSV感染率高于hMPV感染率,两者所致肺炎在发病年龄、性别及临床症状上无显著区别。     

老年社区获得性肺炎患者TNF-alpha和sTREM-1 的表达及临床意义

目的:探讨老年社区获得性肺炎患者TNF-α和s TREM-1表达水平及其临床意义。方法:从我院选择48例社区获得性肺炎患者为CAP组(重症组和普通组),另选取对照组48例。收集两组患者的血浆及BALF,分别收集重症组患者住院后1天、4天的血浆和BALF,对比各组s TREM-1和TNF-α的表达水平。结果:对照组TNF-α和s TREM-1的表达水平均低于CAP组(P<0.05);重症患者的TNF-α和s TREM-1表达水平高于普通组和健康对照组(P<0.05)。重症患者TNF-α表达水平与对照组无显著差异(P>0.05),而s TREM-1表达高于对照组,差异有统计学意义(P<0.05)。结论:TNF-α和s TREM-1表达水平与CAP的发病过程密切相关,其表达水平与CAP的严重程度呈正相关。