重症肺炎新生儿支气管肺泡灌洗液病原菌分布及耐药性

目的 研究重症肺炎新生儿支气管肺泡灌洗液的病原菌分布和耐药性。方法 选择2016年4月至2018年4月在本院呼吸科治疗的新生儿268例,其中符合重症肺炎诊断标准的患儿142例,归为重症肺炎组;不符合重症肺炎诊断标准的患儿126例,归为对照组。检测患儿肺泡灌洗液病原菌分布情况和耐药情况。结果 重症肺炎组患儿肺炎克雷伯菌、流感嗜血菌、铜绿假单胞菌、阴沟肠杆菌、大肠埃希菌、金黄葡萄球菌、溶血葡萄球菌、表皮葡萄球菌、肺炎链球菌、草绿链球菌检出率明显高于对照组。肺炎克雷伯菌对亚胺培南,美罗培南的耐药性为0.0%,大肠埃希菌对亚胺培南,美罗培南,阿米卡星的耐药性为0.0%,阴沟肠杆菌对亚胺培南,美罗培南,左氧氟沙星的耐药性为0.0%,肺炎链球菌对万古霉素的耐药性为0.0%,金黄葡萄球菌对万古霉素的耐药性为0.0%。结论 新生儿重症肺炎患者病原菌以革兰阴性菌为主,亚胺培南、美罗培南、万古霉素可以用于治疗新生儿重症肺炎,但由于其毒副作用较大,应严格把握适应症。     

阿奇霉素序贯治疗联合硫酸特布他林对肺炎支原体肺炎患儿肺功能和血清IL-6、CRP、PCT水平的影响

摘要 目的：探讨阿奇霉素序贯治疗联合硫酸特布他林对肺炎支原体肺炎（MPP）患儿肺功能和血清白介素-6（IL-6）、降钙素原（PCT）、C反应蛋白（CRP）水平的影响。方法：于2018年1月-2019年12月期间,选取80例来我院就诊的MPP患儿,根据入院顺序将患儿分为对照组（40例,阿奇霉素序贯治疗）和实验组（40例,阿奇霉素联合硫酸特布他林治疗）,对比两组疗效、住院时间及临床症状缓解时间、肺功能、不良反应及血清炎症因子水平。结果：实验组的胸片恢复正常时间、住院时间、啰音消失时间、退热时间、咳嗽消失时间短于对照组（P<0.05）。实验组治疗后的临床总有效率95.00%（38/40）高于对照组的77.50%（31/40）（P<0.05）。实验组治疗后用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、呼气峰值流速（PEF）均高于对照组,IL-6、PCT、CRP均低于对照组（P<0.05）。两组不良反应发生率组间对比无明显差异（P>0.05）。结论：阿奇霉素序贯治疗联合硫酸特布他林治疗MPP患儿,可有效缓解临床症状,降低机体炎症反应,改善患儿肺功能,不良反应轻微,协同作用显著。     

肺炎支原体肺炎患儿血清sB7-H3含量与细胞因子水平及病情严重程度的相关性研究

摘要 目的：研究肺炎支原体肺炎（mycoplasma pneumoniae pneumonia, MPP）患儿血清可溶性共刺激分子B7-H3（soluble co-stimulatory molecule B7-H3, sB7-H3）含量与细胞因子水平及病情严重程度的相关性。方法：收集2019年3月至2020年6月期间我院收治的MPP患儿共96例,根据患儿病情严重程度分为轻症MPP组和重症MPP组,另选取同期于我院体检中心体检的健康儿童50例作为对照组。收集所有受试者的一般资料、主要临床表现、临床指标及细胞因子水平,对各指标进行Pearson相关性分析和多元逐步回归分析。结果：与对照组相比,MPP组患儿的白细胞计数（white blood cell, WBC）、中性粒细胞计数（neutrophil, NE）、红细胞沉降率（erythrocyta sedimentation rate, ESR）、C反应蛋白（C-reactive protein,CRP）、sB7-H3、粒细胞-巨噬细胞集落刺激因子（granulocyte-macrophage colony stimulating factor, GM-CSF）、干扰素-γ（interferon-γ, IFN-γ）、白介素-10（interleukin-10,IL-10）和白介素-17A（interleukin-17A,IL-17A）均较高（P＜0.05）;与轻症MPP组患儿相比,重症MPP组患儿的WBC、NE、ESR、CRP、sB7-H3、GM-CSF、IFN-γ、IL-10和IL-17A均较高（P＜0.05）。Pearson相关性分析结果表明,sB7-H3与WBC、NE、ESR、CRP、GM-CSF、IFN-γ、IL-10和IL-17A呈正相关（P＜0.05）。多元线性回归分析显示,GM-CSF（β=0.103,P＜0.001）、IFN-γ（β=0.121,P＜0.001）、IL-10（β=0.026,P＜0.001）和IL-17A（β=0.093,P＜0.001）是sB7-H3的独立影响因素。结论：MPP患儿血清sB7-H3、GM-CSF、IFN-γ、IL-10和IL-17A与MPP的病情严重程度密切相关,且sB7-H3的表达水平与GM-CSF、IFN-γ、IL-10和IL-17A的水平呈正相关。     

肺炎支原体肺炎患儿外周血白介素的表达与肺功能变化的相关性

目的:探讨肺炎支原体(MPP)肺炎患儿外周血中IL-10、IL-17的表达水平与肺功能变化的相关性。方法:选取70例肺炎支原体肺炎患儿为研究对象,以是否有哮鸣音分为喘息组和非喘息组,以30例健康儿童为对照组,空腹采血5ml,分离血清,ELISA检测血清中IL-10、IL-17的表达水平,肺功能检测仪检测受检者的第一秒用力呼气容积(PEV1),最大呼气流量(PEF),用力肺活量(FEV1/FVC)。结果:喘息组中IL-10的表达水平与对照组相比差异显著(P0.05),喘息组中IL-10的表达水平与非喘息组相比差异显著(P0.05),喘息组中IL-17的表达水平与对照组相比差异显著(P0.05),喘息组中IL-17的表达水平与非喘息组相比差异显著(P0.05)。喘息组和非喘息组中IL-10水平均低于对照组,喘息组和非喘息组中IL-17水平均高于于对照组。非喘息组较喘息组PEV1、PEF、PVE1/FVC值高,差异显著(P0.05)。肺炎支原体肺炎患儿血清中的IL-10的水平与PEV1、PEF、PVE1/FVC呈正相关,肺炎支原体肺炎患儿血清中的IL-17的水平与PEV1、PEF、PVE1/FVC呈负相关。结论:肺炎支原体肺炎患儿血清中IL-10、IL-17的表达水平与肺功能密切相关。     

麻杏石甘汤合玉屏风散对支原体肺炎患儿血清炎症因子、氧化应激及T淋巴细胞亚群的影响

目的:探讨麻杏石甘汤合玉屏风散对支原体肺炎患儿血清炎症因子、氧化应激及T淋巴细胞亚群的影响.方法:选取我院儿科门诊于2016年12月至2018年7月间收治的86例支原体肺炎患儿,按随机数字表法分为观察组(43例)和对照组(43例).对照组采用常规治疗,观察组在对照组基础上联合使用麻杏石甘汤合玉屏风散治疗,两组均治疗14...     

Circ_0026579 alleviates LPS-induced WI-38 cells inflammation injury in infantile pneumonia

Circular RNA (circRNA) represents an important regulator in infantile pneumonia progression. To clarify the role of circ_0026579 in this disease, LPS was used to treat WI-38 cells to mimic inflammation injury. The levels of inflammatory factors were determined by ELISA assay. Cell proliferation and apoptosis were measured by MTT assay, EdU staining and flow cytometry. The protein levels of cyclinD1, cleaved-caspase-3 and insulin-like growth factor 2 (IGF2) were examined using Western blot analysis. Cell oxidative stress was assessed by detecting MDA level and SOD activity. The expression of circ_0026579, miR-24-3p and IGF2 were analyzed using quantitative real-time PCR, and the interaction between miR-24-3p and circ_0026579 or IGF2 was confirmed by dual-luciferase reporter assay and RIP assay. LPS induced inflammation in WI-38 cells. Circ_0026579 expression was promoted in LPS-induced WI-38 cells, and its knockdown alleviated LPS-induced WI-38 cells inflammation. MiR-24-3p was sponged by circ_0026579, and its expression was reduced by LPS. MiR-24-3p inhibitor reversed the regulation of circ_0026579 knockdown on LPS-induced WI-38 cells inflammation. IGF2 was targeted by miR-24-3p, and its expression could be enhanced by LPS. MiR-24-3p relieved the inflammation of WI-38 cells which could be abolished by IGF2 overexpression. Circ_0026579 positively regulated IGF2 expression through sponging miR-24-3p. Circ_0026579 knockdown alleviated LPS-induced WI-38 cells inflammation by miR-24-3p/IGF2 axis, suggesting that circ_0026579 might contribute to infantile pneumonia progression.     

经鼻加温加湿高流量吸氧对重症肺炎伴呼吸衰竭患儿血气指标、肺功能及细胞因子水平的影响

摘要 目的：观察经鼻加温加湿高流量吸氧（HFNC）对重症肺炎伴呼吸衰竭患儿血气指标、肺功能及细胞因子水平的影响。方法：选取南京医科大学附属儿童医院2020年3月~2022年3月期间收治的86例重症肺炎伴呼吸衰竭患儿,按照随机数字表法分为经鼻持续气道正压通气（nCPAP）组和HFNC组,各为43例。对比两组临床相关指标、血气指标、肺功能及细胞因子水平,同时观察两组镇静剂使用、预后及并发症发生情况。结果：HFNC组的机械通气时间、咳嗽缓解时间、肺部啰音消失时间、入住儿童重症监护室（PICU）时间均短于nCPAP组（P<0.05）。两组患儿治疗后心率（HR）升高,呼吸频率（RR）下降,且HFNC组的变化大于nCPAP组（P<0.05）。两组患儿治疗后pH值、血氧分压（PO₂）、血氧饱和度（SpO₂）、氧合指数（OI）均升高,且HFNC组高于nCPAP组（P<0.05）。两组患儿治疗后用力肺活量（FVC）、1s用力呼气容积（FEV1）、用力呼气时最高呼气流速（PEF）升高,且HFNC组高于nCPAP组（P<0.05）。两组患儿治疗后降钙素原（PCT）、白细胞介素（IL-6）和肿瘤坏死因子（TNF-α）下降,且HFNC组低于nCPAP组（P<0.05）。HFNC组镇静剂使用、再住院例数均少于nCPAP组（P<0.05）。两组死亡例数、并发症发生率组间对比未见统计学差异（P>0.05）。结论：HFNC可有效缓解重症肺炎伴呼吸衰竭患儿的临床症状,改善血气指标、肺功能及细胞因子水平。     

Host genetic risk factors for community-acquired pneumonia

This study was conducted to establish the contribution of genetic host factors in the susceptibility to community acquired pneumonia (CAP) in the Russian population. Patients with CAP (n = 334), volunteers without a previous history of CAP, constantly exposed to infectious agents, control A group (n = 141) and a second control group B consisted of healthy persons (n = 314) were included in the study. All subjects were genotyped for 13 polymorphic variants in the genes of xenobiotics detoxification CYP1A1 (rs2606345, rs4646903, and rs1048943), GSTM1 (Ins/del), GSTT1 (Ins/del), ABCB1 rs1045642); immune and inflammation response IL-6 (rs1800795), TNF-a (rs1800629), MBL2 (rs7096206), CCR5 (rs333), NOS3 (rs1799983), angiotensin-converting enzyme ACE (rs4340), and occlusive vascular disease/hyperhomocysteinemia MTHFR (rs1801133). Seven polymorphic variants in genes CYP1A1, GSTM1, ABCB1, NOS3, IL6, CCR5 and ACE were associated with CAP. For two genes CYP1A1 and GSTM1 associations remained significant after correction for multiple comparisons. Multiple analysis by the number of all risk genotypes showed a highly significant association with CAP (P = 2.4 × 10^− 7, OR = 3.03, 95% CI 1.98–4.64) with the threshold for three risk genotypes. Using the ROC-analysis, the AUC value for multi-locus model was estimated as 68.38.     

重症肺炎患儿俯卧位与仰卧位机械通气的临床效果比较及其脱机结局的影响因素分析

摘要 目的：比较重症肺炎患儿俯卧位与仰卧位机械通气的临床效果,并分析其脱机结局的影响因素。方法：选择2020年5月~2021年12月期间在我院重症监护室（ICU）住院的重症肺炎患儿120例作为研究对象。根据机械通气体位方式的不同将患儿分为仰卧组（n=52）和俯卧组（n=68）,对比仰卧组、俯卧组的临床症状改善时间和血气分析指标[动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、平均动脉压（MAP）]。记录仰卧组、俯卧组的死亡例数、脱机成功和脱机失败例数,计算死亡率、脱机失败发生率。采用单因素及多因素Logistic回归分析脱机失败的影响因素。结果：俯卧组的发热消失时间、肺部啰音消失时间、呼吸改善时间短于仰卧组（P<0.05）。两组治疗5 d后 PaO₂、MAP较治疗前升高,PaCO₂较治疗前下降（P<0.05）;俯卧组的PaO₂、MAP高于仰卧组,PaCO2低于仰卧组（P<0.05）。两组患儿死亡率组间对比未见统计学差异（P>0.05）。俯卧组的脱机失败率低于仰卧组（P<0.05）。在120例患儿中,死亡7例,根据重症肺炎患儿脱机结局将剩余113例分为脱机成功组（n=72）和脱机失败组（n=41）,脱机失败组、脱机成功组在年龄、急性生理与慢性健康评分系统II（APACHE II）评分、病程、先天性病史、D-二聚体（D-D）、白蛋白（ALB）、血乳酸、脑尿钠肽（BNP）方面对比有统计学差异（P<0.05）。多因素Logistic回归分析结果显示：年龄偏小、APACHE II评分偏高、D-D偏高、ALB偏低、先天性病史均是重症肺炎患儿脱机结局的影响因素（P<0.05）。结论：与仰卧位相比,俯卧位机械通气用于重症肺炎患儿可获得更好的临床效果和脱机成功率,且患儿的脱机结局受到年龄、APACHE II评分、D-D、ALB、先天性病史的影响。     

Effects of Surfactant Protein-A on the Interaction of Pneumocystis murina with its Host at Different Stages of the Infection in Mice

ABSTRACT. We examined the effects of surfactant protein A (SP-A), a collectin, on the interaction of Pneumocystis murina with its host at the beginning, early to middle, and late stages of infection. Pneumocystis murina from SP-A wild-type (WT) mice inoculated intractracheally into WT mice (WT_S-WT_R) adhered well to alveolar macrophages, whereas organisms from SP-A knockout (KO) mice inoculated into KO mice (KO_S-KO_R) did not. Substitution of WT mice as the source of organisms (WT_S-KO_R) or recipient host macrophages (KO_S-WT_R) restored adherence to that found with WT_S-WT_R mice. In contrast, when immunosuppressed KO and WT mice were inoculated with P. murina from a homologous source (KO_S-KO_R, WT_S-WT_R) or heterologous source (WT_S-KO_R, KO_S-WT_R) and followed sequentially, WT_S-KO_R mice had the highest levels of infection at weeks 3 and 4; these mice also had the highest levels of the chemokine macrophage inflammatory protein-2 and neutrophils in lavage fluid at week 3. Surfactant protein-A administered to immunosuppressed KO_S-KO_R mice with Pneumocystis pneumonia for 8 wk as a therapeutic agent failed to lower the organism burden. We conclude that SP-A can correct the host immune defect in the beginning of P. murina infection, but not in the middle or late stages of the infection.