呼吸道感染患者痰液病原菌分布及血清SAA、IL-9、sICAM-1水平与病情严重程度、预后的关系-现代医学

呼吸道感染患者痰液病原菌分布及血清SAA、IL-9、sICAM-1水平与病情严重程度、预后的关系

单位：1. 淮安市第二人民医院感染性疾病科, 江苏淮安 223001;
2. 淮安市第二人民医院全科医学科, 江苏淮安 223001;
3. 淮安市第二人民医院呼吸与危重症科, 江苏淮安 223001

关键词：痰液病原菌血清淀粉样蛋白A 白细胞介素-9 可溶性细胞间黏附分子-1 病情严重程度预后

分类号：R446.5;R56

出版年·卷·期（页码）：2024·52·第十二期（1850-1856）

摘要：

目的：探究呼吸道感染患者痰液病原菌分布及血清淀粉样蛋白A (SAA)、白细胞介素-9(IL-9)、可溶性细胞间黏附分子-1(sICAM-1)水平与病情严重程度、预后的关系。方法：回顾性选取2022年6月至2023年6月于我院就诊的呼吸道感染患者者81例，对照为同期健康体检者81例。对感染者随访6个月，比较其不同程度病情下痰液病原菌分布、SAA、IL-9、sICAM-1的水平以及三指标对预后的影响。结果：81例患者痰液经病原菌培养共分离出105株病原菌株，其中革兰阴性菌类数量最多，占61.90%(65/105)，其次为革兰阳性菌，占26.67%(28/105)，真菌占11.43%(12/105)。感染组SAA、IL-9、sICAM-1的表达水平与健康组相比，均呈高表达(P＜0.001)。在感染患者中，处于中度感染的SAA、IL-9、sICAM-1水平值相较于轻微感染更高，差异有统计学意义(P＜0.05)；随访后，复发与非复发组性别、年龄、吸烟史、饮酒史、冠心病、高血压、糖尿病比较差异均无统计学意义(P＞0.05)，病情严重程度、SAA、IL-9、sICAM-1差异有统计学意义，是复发的相关因素(P＜0.05)。Logistic回归模型显示，中度症状、SAA≥85.00 mg·L^-1、IL-9≥25.42 ng·L^-1、sICAM-1≥1.13 ng·mL^-1是呼吸道感染患者复发的危险因素(P＜0.05)。结论：呼吸道中度感染患者痰液病原菌数量多于轻微感染患者，肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌多见。中度感染的SAA、IL-9、sICAM-1表达比轻微更高。感染程度、SAA、IL-9、sICAM-1表达水平会影响呼吸道感染患者复发。

Objective:To exploring the distribution of pathogenic bacteria in sputum of patients with respiratory infections and the relationship between serum amyloid A protein(SAA), interleukin-9(IL-9), soluble intercellular adhesion molecule-1(sICAM-1) levels and the severity and prognosis of the disease. Methods: A retrospective selection was conducted on 81 patients with respiratory tract infections who visited our hospital from June 2022 to June 2023.The control group consisted of 81 healthy individuals who underwent physical examinations during the same period. The infected individuals were followed up for six month. The distribution of sputum pathogens, levels of SAA, IL-9, and sICAM-1 under different degrees of illness were compared as well as the impact of the three indicators on prognosis. Results: A total of 105 pathogenic strains were isolated from the sputum of 81 patients through pathogen culture, among which Gram-negative bacteria were the most numerous, accounting for 61.90%(65/105), followed by Gram-positive bacteria at 26.67%(28/105), and fungi accounting for 11.43%(12/105). The expression levels of SAA, IL-9, and sICAM-1 in the infected group were higher than those in the healthy group(P<0.001). Among infected patients, the levels of SAA, IL-9, and sICAM-1 were higher in moderate infections compared with tomild infections, with significant differences(P<0.05). After follow-up, there were no statistically significant differences in gender, age, smoking history, drinking history coronary heart disease, hypertension, and diabetes between the recurrent and non recurrent groups(P>0.05). However, there were statistically significant differences in symptom severity, SAA, IL-9, and sICAM-1, which were related factors for recurrence(P<0.05). Logistic regression model analysis showed moderate symptoms, SAA ≥85.00 mg·L^-1, IL-9≥25.42 ng·L^-1, and sICAM-1 ≥1.13 ng·mL^-1were the risk factors for recurrence in patients with respiratory infections(P<0.05). Conclusion:Patients with moderate respiratory tract infections have more pathogenic bacteria in their sputum than those with mild infections, with Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus being more common. The levels of SAA, IL-9, and sICAM-1 are higher in moderate infections than in mild infections. The degree of infection, expression levels of SAA, IL-9, and sICAM-1 can affect the recurrence of respiratory infection patients.

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