表面活性蛋白D及白细胞介素-10基因多态性与老年2型糖尿病并发肺部感染的关联

目的 分析老年2型糖尿病(T2DM)并发肺部感染病原学特点及表面活性蛋白D(SP-D)、白细胞介素-10(IL-10)基因多态性。方法 选择2018年1月-2020年9月宁夏医科大学附属银川市中医医院收治的老年T2DM并发肺部感染患者42例为感染组,同期收治的老年T2DM未并发肺部感染患者70例为未感染组。分析感染患者病原菌分布,采用限制性片段长度多态性聚合酶链反应(PCR-RELP)检测两组患者SP-D基因Met11Thr (rs721917 T/C)位点、IL-10基因-1082 (rs1800896 G/A)位点基因型。结果 42例感染组患者共分离出58株病原菌,其中革兰阴性菌38株占65.52%,革兰阳性菌19株占32.76%,真菌1株占1.72%。两组患者年龄、T2DM病程比较,差异有统计学意义(P<0.05)。两组SP-D基因Met11Thr (rs721917 T/C)位点基因型频率分布差异有统计学意义(P<0.05),感染组C等位基因频率高于未感染组(P<0.05);两组IL-10基因-1082 (rs1800896 G/A)位点基因型频率分布无统计学差异,但感染组G等位基因频率高于未感染组(P<0.05)。结论老年T2DM并发肺部感染病原菌以革兰阴性菌为主,SP-D、IL-10基因多态性与感染关系密切。     

2型糖尿病肾病患者并发肺部感染表面活性蛋白 D基因多态性与影响因素分析

目的探究分析2型糖尿病肾病患者并发肺部感染表面活性蛋白D(Surfactant protein D,SP-D)基因多态性与影响因素分析。方法选择2015年1月-2018年12月山东省千佛山医院收治的2型糖尿病肾病患者90例,根据是否并发肺部感染分为感染组41组和未感染组49例。采用PCR-限制性片段长度多态性(PCR-RFLP)分析法检测SP-D基因Met11Thr(rs721917T/C)多态性,并检测SP-D水平,并归纳2型糖尿病患者并发肺部感染的影响因素。结果肺部感染组血清SP-D为(23.74±4.16)ng/L高于未感染(P<0.001);肺部感染组rs721917 T/C位点的TT基因型频率为14.63%(6/41)、CT基因型频率为31.71%(13/41)、CC基因型频率为53.66%(22/41)与未感染组比较差异有统计学意义(P<0.05);肺部感染组的rs721917 T/C位点C等位基因频率69.51%(57/82)、T等位基因频率30.49%(25/82)与未感染组比较差异有统计学意义(P<0.05);年龄、糖尿病病程、维持性血液透析、肾功能为失代偿期是2型糖尿病肾病患者并发肺部感染的影响因素(P<0.05)。结论 2型糖尿病肾病患者并发肺部感染患者的SP-D水平呈升高趋势,可为肺部感染诊断提供参考,SP-D基因Met11Thr(rs721917 T/C)位点多态性可能与肺炎感染的易感性有关,C基因可能为易感基因,T基因为保护基因;此外特别注意高龄、糖尿病病程长、需要维持性血液透析、肾功能为失代偿期的易感染人群,减少肺部感染的发生率。     

瘦素受体基因Gln223Arg、锰超氧化物歧化酶9Ala/Val基因多态性与吸烟的交互作用和非酒精性脂肪性肝病关系

目的探讨瘦素受体(LEPR)基因Gln223Arg、锰超氧化物歧化酶9Ala/Val(manganese superoxide dismutase9Ala/Val,MnSOD9Ala/Val)基因多态性与吸烟的交互作用与非酒精性脂肪性肝病(NAFLD)的关系。方法采用病例-对照研究的方法,以600例NAFLD患者及600例健康对照者的外周血白细胞为样本,利用PCR分析LR基因Gln223Arg和MnSOD9Ala/Val基因多态性。结果 LR基因LEPR Gln223Arg(G/G)基因型和MnSOD9Ala/Val(V/V)基因型频率分布分别为48.67%、50.17%(病例组)和21.17%、21.50%(对照组),二者经χ2检验差异有显著性(P0.01;P0.01)。Gln223Arg(G/G)患NAFLD的风险显著增加(OR=3.5309,95%CI 1.8165~5.0724)。MnSOD9Ala/Val(V/V)基因型者患NAFLD的风险也显著增加(OR=3.6756,95%CI=1.9137~5.5496)。基因突变的协同分析发现Gln223Arg(G/G)/MnSOD9Ala/Val(V/V)基因型者在NAFLD组和对照组中的分布频率分别为40.33%%和7.50%,二者经χ2检验有显著性差异(P0.01)。Gln223Arg(G/G)/MnSOD9Ala/Val(V/V)基因型者患NAFLD的风险显著增加(OR=8.4014,95%CI 4.2926~12.4238)。病例组的吸烟率显著高于对照组的吸烟率(OR=3.6754,95%CI 1.4193~4.9581,P0.01),吸烟与Gln223Arg(G/G)和MnSOD9Ala/Val(V/V)基因型均有交互作用(OR=8.5476;OR=8.8665)。结论Gln223Arg(G/G)/MnSOD9Ala/Val(V/V)基因型和吸烟是NAFLD的易患因素,基因多态性与吸烟的交互作用增加了NAFLD的发病风险。     

XPC基因Ala499Val和Lys939Gln多态与癌症发病风险关联的meta分析

目的 为更清楚地了解NER通路上的XPC基因多态性与癌症发病风险的关联.方法 利用所有已发表的相关病例-对照研究对两个重要单核苷酸多态性位点:Ala499Val 和Lys939Gln进行了meta-分析.结果 Ala499Val位点的总体分析发现,499TT基因型的个体比499CT及499CC基因型个体,其癌症发病风险高25%(OR = 1.25,95% CI =1.09-1.44);499CT杂合基因型个体的癌症发病风险较纯合基因型个体低10% (OR = 0.90,95%CI = 0.84-0.97).Lys939Gln位点的总体分析发现,939CC基因型的个体比939CA与939AA基因型个体的癌症发病风险略高8% (OR = 1.08,95%CI = 1.00-1.16).此外,依据癌症种类和人群的不同对两个位点的亚组分析结果发现,Lys939Gln位点在高加索人群中与癌症发病风险显著相关.结论 499T和939C均为风险性的等位基因.499TT或939CC基因型的个体、尤其是939CC基因型的高加索人,有更高的癌症发生的可能性.     

肺癌化疗患者肺部感染病原学及其与SP-D基因多态性的关联性

目的 研究肺癌化疗患者肺部感染病原学特点、危险因素及其与表面活性蛋白D(SP-D)基因多态性的关联性。方法 选取2018年1月-2020年12月南通市第一人民医院796例肺癌化疗患者临床资料为样本开展横断面研究，诊断有无肺部感染并进行病原学分析，同时检测SP-D基因多态性，根据肺部感染情况分为感染组92例和非感染组704例，比较两组临床资料并分析SP-D基因多态性对肺部感染的影响。结果 796例肺癌化疗患者发生肺部感染92例，占比11.56%,共检出病原菌146株，其中革兰阴性菌82株(56.16%),革兰阳性菌53株(36.30%),真菌11株(7.53%);感染组年龄、糖尿病占比、血清白蛋白(ALB)、化疗周期和住院时间高于非感染组，应用抗菌药物患者占比低于非感染组(P<0.05);感染组和非感染组SP-D基因rs2243639 A/G、rs3088308 A/T和rs721917 T/C位点基因型分布均满足Hardy-Weinber平衡定律，且感染组SP-D基因rs721917 T/C位点CC基因型和C等位基因分布频率均高于非感染组(P<0.05);多因素Logistic回归分析结果显示，年龄、糖尿病、化疗周期和SP-D基因rs721917 CC基因型为肺癌患者肺部感染独立危险因素(P<0.05),ALB和应用抗菌药物为保护因素(P<0.05)。结论 肺癌化疗患者肺部感染发生风险较高，病原菌分布主要为革兰阴性菌，同时SP-D基因rs721917 CC基因型可能导致肺部感染易感性增加。     

前列腺增生术后尿路感染病原菌及表面活性蛋白A/D水平

目的 探讨前列腺增生术后尿路感染患者表面活性蛋白A/D(SP-A/D)改变及其与T细胞免疫的关系。方法 选择海口市第三人民医院泌尿外科2016年5月-2020年5月收治进行前列腺增生手术患者作为研究对象,选取术后尿路感染与未感染者各55例。对尿路感染病原菌分布进行调查;采用酶联免疫吸附法检测尿液中SP-A、SP-D蛋白水平,采用流式细胞术检测外周血中CD_4⁺、CD_8+、CD_8⁺、CD_4+、CD_4⁺/CD_8+/CD_8⁺水平。结果 55例尿路感染患者经培养共分离出病原菌60株,其中革兰阴性菌43株,占71.67%,革兰阳性菌17株,占28.33%,大肠埃希菌检出率较高,共23株,占38.33%;感染组SP-A、SP-D、CD_8+水平。结果 55例尿路感染患者经培养共分离出病原菌60株,其中革兰阴性菌43株,占71.67%,革兰阳性菌17株,占28.33%,大肠埃希菌检出率较高,共23株,占38.33%;感染组SP-A、SP-D、CD_8⁺高于非感染组,CD_4+高于非感染组,CD_4⁺、CD_4+、CD_4⁺/CD_8+/CD_8⁺低于非感染组,差异具有统计学意义(P<0.05)。重度组SP-A、SP-D、CD_8+低于非感染组,差异具有统计学意义(P<0.05)。重度组SP-A、SP-D、CD_8⁺及IPSS评分高于中度组及轻度组,CD_4+及IPSS评分高于中度组及轻度组,CD_4⁺、CD_4+、CD_4⁺/CD_8+/CD_8⁺低于中度组及轻度组,中度组SP-A、SP-D、CD_8+低于中度组及轻度组,中度组SP-A、SP-D、CD_8⁺及IPSS评分高于轻度组,CD_4+及IPSS评分高于轻度组,CD_4⁺、CD_4+、CD_4⁺/CD_8+/CD_8⁺低于轻度组,差异均具有统计学意义(P<0.05);ROC分析结果显示,尿液SP-A、SP-D及IPSS评分对前列腺增生术和尿路感染的诊断价值曲线下面积分别为0.715、0.732、0.682,指标联合时曲线下面积为0.785,均具有统计学意义(P<0.05)。结论 尿液SP-A、SP-D水平可反映前列腺增生术后尿路感染及T细胞免疫状态,对于判断尿路感染有一定临床价值。     

对氧磷酶1 55 Met/Leu、对氧磷酶2 148 Ala/Gly和锰超氧化物歧化酶9 Ala/Val基因多态性与冠心病

目的 探讨对氧磷酶155 Met/Leu(PON1 55 Met/Leu)、对氧磷酶2148 Ala/Gly(PON2148 Ala/Gly)和锰超氧化物歧化酶9 Ala/Val(MnSOD 9 Ala/Val)基因多态性与冠心病(CHD)、血浆对氧磷酶(PON)、总超氧化物歧化酶(T-SOD)和锰超氧化物歧化酶(MnSOD)活性以及丙二醛(MDA)浓度的关系.方法 采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测262例CHD患者和100名对照组的PON1 55 Met/Leu、PON2 148 Ala/Gly和MnSOD 9 Ala/Val基因多态性的基因型,采用比色法测定血浆PON、T-SOD和MnSOD活性以及MDA浓度.结果 与对照组比较,CHD患者的血浆PON[(349.27±138.36 vs 454.75±166.00)nmol·min-1·ml-1,P＜0.001]、T-SOD[(23.61±16.51 vs.44.01±22.68)U/ml,P＜0.001]和MnSOD活性[(21.56±13.11 vs.28.79±8.65)U/ml,P＜0.001]明显降低,MDA浓度显著增高[(2.47±0.73 vs.2.15±0.55)nmol/ml,P＜0.01];CHD患者的PON1 55 LM杂合子基因型、M等位基因频率,PON2 148 GG纯合子基因型和AG杂合子基因型、G等位基因频率和MnSOD 9 AA基因型、A等位基因频率较对照组明显增多;PON1 55 LM杂合子基因型的PON和T-SOD活性较LL纯合子基因型明显降低;PON2 148GG基因型和AG基因型的PON活性较AA基因型明显降低;MnSOD AA基因型的PON和MnSOD活性较VV基因型明显降低;logistic回归分析显示PON1 55 LM杂合子基因型、M等位基因、PON2148 GG/AG基因型、G等位基因是CHD的危险因子.结论 CHD患者的抗氧化能力明显降低,脂质过氧化物显著增高;PON1 55 Met/Leu、PON2 148 Ala/Gly和MnSOD 9 Ala/Val基因多态性通过影响血浆PON和MnSOD活性而参与CHD的发病.     

FABP2 Ala54Thr基因多态性与非酒精性脂肪肝关联的研究

目的探讨肠型脂肪酸结合蛋白(FABP)2基因Ala54Thr多态性与非酒精性脂肪肝的关系。方法以聚合酶链反应(PCR)和限制性片段长度多态性(RFLP)方法,检测了234例非酒精性脂肪肝患者和476例正常对照者的FABP2基因Ala54Thr多态性,同时按照流行病学方法设计调查表进行问卷调查。结果FABP2基因型Ala54Ala、Ala54Thr和Thr54Thr在病例组中分别为39.7%、46.6%和13.7%,在对照组中分别为48.5%、43.1%和8.4%,差异有显著性(P<0.05)。病例组Thr等位基因频率(36.97%)明显高于对照组(29.94%)(P=0.01)。多因素Logistic回归分析显示,在调整混杂因素影响后,Thr54Thr基因型仍是非酒精性脂肪肝发病的独立危险因素,OR值为1.97,95%CI为1.18～3.35。结论FABP2基因Ala54Thr突变可能是非酒精性脂肪肝发病的遗传易感因素。     

多ADP-核糖聚合酶Val762Ala多态性与急性冠状动脉综合征的关系

目的探讨多ADP-核糖聚合酶[poly(ADP-ribose)polymerase,PARP]单核苷酸多态性位点Val762Ala基因多态性与急性冠状动脉综合征(acute coronary syndrome,ACS)的关系。方法选择2007年7月—2008年4月经冠状动脉造影确诊的ACS患者84例为病例组和非ACS患者87例为对照组,检测两组PARP的表达,并采用Se-quenom公司MassARRAY时间飞行质谱生物芯片系统单核苷酸多态性基因型分析技术对其进行PARP基因单核苷酸位点Val762Ala基因分型。比较两组间Val762Ala的基因型分布。结果定量分析可见病例组血浆PARP水平明显高于对照组(P0.05)。Val762Ala位点成功分型率为98.5%,病例组与对照组TC+CC基因型频率分别为86.9%和20.7%,两组差异有统计学意义(P0.05)。结论 PARP水平与冠状动脉粥样斑块稳定性有相关性,可能是致冠状动脉斑块破裂的重要原因之一。Val762Ala多态性与粥样硬化斑块破裂可能存在相关性。     

DNA损伤修复基因hMTH 1多态性与尘肺发病风险相关性研究

目的探究h MTH 1基因型分布与尘肺发病风险的关系,为进一步阐明尘肺的发生发展以及防治尘肺提供新的线索。方法采用病例对照的研究方法,分别收集尘肺组和对照组的个人相关资料,采集外周血样本并提取DNA,利用聚合酶链反应-限制性片段长度多态性分析技术(PCR-RFLP),分析h MTH 1基因内含子4中c.Val 83 Met位点的多态性。结果 h MTH 1基因3种基因型(c.83 Val/Val、Val/Met、Met/Met)在病例组和对照组中的频率分布差异无统计学意义(χ2=0.92,P=0.38)。并且基因型Val/Val和Val/Met+Met/Met(即至少携带一个编码Met的等位基因)在尘肺组和对照组中的分布频率差异无统计学意义。结论 h MTH 1 Va l83 Met多态性与尘肺病的发病风险可能无关。     

Salmonellas in pigs and animal feeding stuffs in England and Wales and in Denmark

A comparison has been made between the incidence of salmonellas in pigs and feeding stuffs in England and Wales and in Denmark. In Denmark there is veterinary legislation requiring the sterilization of imported and home produced feed ingredients of animal origin. There is no such legislation in England and Wales. In Denmark 0·3% of resterilized imported meat and bone meal was contaminated with salmonellas. This compared with 23% of meat and bone meal in England and Wales and 20-27% of other ingredients of animal origin. In England and Wales salmonellas were isolated from 7% of caecal samples and 6% of lymph node samples, while in Denmark they were isolated from 3% of caecal samples and 4% of lymph node samples. In England and Wales 25 serotypes were found in both pigs and feeds and these included nearly all the most prevalent human pathogens. In Denmark four of the six serotypes in pigs had been found in resterilized feed. One notable difference between the two studies was the very wide range of serotypes found in pigs in England and Wales and the narrow range in Denmark. A second was that Salmonella typhimurium formed 15% of all Salmonella strains isolated from pigs in England and Wales, and 60% of those in Denmark.     

Lunasin is prevalent in barley and is bioavailable and bioactive in in vivo and in vitro studies

Lunasin, a unique 43-amino acid peptide found in a number of seeds, has been shown to be chemopreventive in mammalian cells and in a skin cancer mouse model. To elucidate the role of cereals in cancer prevention, we report here the prevalence, bioavailability, and bioactivity of lunasin from barley. Lunasin is present in all cultivars of barley analyzed. The liver and kidney of rats fed with lunasin-enriched barley (LEB) show the presence of lunasin in Western blot. Lunasin extracted from the kidney and liver inhibits the activities of HATs (histone acetyl transferases), yGCN5 by 20% and 18% at 100 nM, and PCAF activity by 25% and 24% at 100 nM, confirming that the peptide is intact and bioactive. Purified barley lunasin localizes in the nuclei of NIH 3T3 cells. Barley lunasin added to NIH 3T3 cells in the presence of the chemical carcinogen MCA activates the expression of tumor suppressors p21 and p15 by 45% and 47%, decreases cyclin D1 by 98%, and inhibits Rb hyperphosphorylation by 45% compared with the MCA treatment alone. We conclude that lunasin is prevalent in barley, bioavailable, and bioactive and that consumption of barley could play an important role of cancer prevention in barley-consuming populations.     

Management of pregnancy and childbirth in England and Wales and in France

This paper reviews national data on obstetric and neonatal practices in England and Wales, and in France between 1970 and 1980. The data have been derived from national statistics and surveys on national samples of births in 1970, 1975 and 1980 in England and Wales, and 1972, 1976 and 1981 in France. The analysis shows that there was no major difference in pregnancy outcome, but wide variations in medical practices, and their trend over time. The main differences were: in England and Wales a higher number of antenatal visits, a higher percentage of inpatient admissions during pregnancy, a higher rate of induction, more episiotomies, a higher rate of resuscitation at birth, and admission to neonatal special care units; in France, a higher rate of caesarean sections before and during labour, some evidence of a more active management of labour, and a longer hospital post-natal stay. These differences in practice reflect differences in objectives and assessment of the effectiveness of care between the two countries: they point out the need for better monitoring and evaluation of obstetric and neonatal practices.     

Research and teaching in social and preventive medicine and in public health

Summary Both public health and social and preventive medicine are characterised by the common goal of promoting, maintaining and improving health and preventing disease, and both are concerned with a population-related, preventive and environmental perspective. But whereas public health is interdisciplinary and goes far beyond the medical focus, social and preventive medicine is medically based and forms a bridge between public health and medical practice. Research in a department of social and preventive medicine serves to support preventive and medico-social activities in medical practice as well as in public health. This is illustrated by results from research conducted at the author's department during the last twenty years. Examples are research in support of smoking cessation activities, and research used for the planning of care for the elderly. Both the research and the teaching activities of the department take into account the population focus of public health as well as the focus on individual medicine in clinical practice.

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Forschung und Lehre in Sozial-und Präventivmedizin und öffentlicher Gesundheit

Zusammenfassung Sowohl das Gebiet der öffentlichen Gesundheit als auch dasjenige der Sozial-und Präventivmedizin sind durch das Ziel der Förderung, Erhaltung und Verbesserung der Gesundheit sowie der Krankheitsvorbeugung gekennzeichnet, und beide beschäftigen sich mit einer bevölkerungsbezogenen, präventiven und umweltbezogenen Perspektive. Aber während die öffentliche Gesundheit stark interdisziplinär ist und weit über den medizinischen Fokus hinausreicht, ist die Sozial-und Präventivmedizin ein medizinisches Fach und stellt eine Brücke zwischen der öffentlichen Gesundheit und der ärztlichen Praxis dar. Die Forschung in einem Institut für Sozial-und Präventivmedizin dient der Förderung präventiver und sozialmedizinischer Tätigkeiten in der ärztlichen Praxis wie auch in der öffentlichen Gesundheit. Dies wird durch die Forschungstätigkeit des Instituts des Autors aus den letzten 20 Jahren illustriert, wobei Beispiele aus den Gebieten der Förderung der Raucherentwöhnung und der Betreuung behinderter Betagter dargestellt werden. Sowohl in den Forschungs-als auch in den Lehrtätigkeiten des Instituts finden der Bevölkerungsbezug der öffentlichen Gesundheit wie auch der individualmedizinische Ansatz der ärztlichen Praxis ihren Ausdruck.

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La recherche et l'ensignement en médecine sociale et préventive et en santé publique

Résumé La santé publique aussi bien que la médecine sociale et préventive sont caractérisées par le but commun de promouvoir, maintenir et améliorer l'état de santé et de prévenir les maladies, et elles s'orientent vers une perspective de population, de prévention et environnementale. Mais la santé publique est interdisciplinaire et va loin au-delà de la médecine, tandis que la médecine sociale et préventive est basée sur la médecine et représente le lien entre la santé publique et la pratique médicale. La recherche d'un institut de médecine sociale et préventive sert à appuyer les activités préventives et médico-sociales au cabinet médical aussi bien qu'en santé publique. Cela est illustré par des résultats de recherches conduites dans les vingt années passées à l'institut de l'auteur, et les exemples sont tirés de la recherche en appui de la promotion de la cessation de fumée et de la planification de la prise en charge des personnes âgées et handicapées. Les activités de recherche et de l'enseignement de l'institut tiennent compte de la perspective de population cacactéristique de la santé publique, aussi bien que de la dimension de médecine individuelle caractéristique de la pratique clinique.

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Paper presented at a symposium on The Public Health Perspective of Social and Preventive Medicine, in celebration of the 20th anniversary of the Department of Social and Preventive Medicine, University of Berne, 25 June 1992 in Berne.     

Eggs enriched in omega-3 fatty acids and alterations in lipid concentrations in plasma and lipoproteins and in blood pressure

Effects of dietary eggs enriched with omega-3 fatty acids on lipid concentrations in plasma and lipoproteins and blood pressure were determined in 11 men and women in two groups. Group 1 consumed four omega-3 eggs per day during the first 4-wk period and four control eggs for the second 4-wk period. Group 2 ate the same number of eggs in the reverse order. Mean plasma cholesterol concentration was significantly increased by control eggs (P less than 0.01) but unchanged by omega-3 eggs. Mean plasma triglyceride concentration was decreased by omega-3 eggs but increased by control eggs. Both systolic and diastolic blood pressures were significantly lowered by omega-3 eggs in group 1 whereas only systolic pressure was significantly decreased on omega-3 eggs in group 2. The control eggs did not change blood pressure. In conclusion, the omega-3 eggs may be more healthful than the control eggs.     

Bacteriology and constitutional health--genomics and proteomics: concepts in medicine and concepts in health insurance in the past and future

Future discussions on health issues on the individual or society level will be fundamentally linked to genetic dispositions. This genetic world will become reality in the same way the world of hygiene and bacteriology has become real for everyone. Approaches of molecular medicine for public health issues have not yet been created so far. The secret dreams of molecular eugenics must be made public and critically discussed. Up to now only a few monogenetically recessive hereditary diseases can be detected by screening. This kind of screening should be carefully considered. However, for the sciences, for medicine and thus for the physicians in practice, for health care sciences as well as for public health care, new tasks will emerge from genetics and molecular medicine. In individual as well as public health these new tasks will at first mainly turn in on the sphere of diagnosis and specific screening as well as health education and consultation. With regard to the considerable social implications the public health care sector should be aware of the coming issues of molecular medicine in time.     

成人社区及医院获得性肺炎病原菌及耐药性差异

 目的 比较非呼吸机相关医院获得性肺炎（NV-HAP）、呼吸机相关肺炎（VAP）与社区获得性肺炎（CAP）感染病原菌分布及耐药性。方法 回顾性调查2017年10月-2019年9月某院肺炎患者病历资料,按NV-HAP、VAP、CAP定义将患者分别列为NV-HAP组、VAP组、CAP组。收集三组患者痰、支气管肺泡灌洗液、血标本培养病原菌及药敏试验结果,分析三组患者感染病原菌构成和耐药性差异。结果 共纳入肺炎患者4 391例,NV-HAP组1 080例,VAP组126例,CAP组3 185例,各组分别检出病原菌841、191、1 440株,均以革兰阴性（G^-）菌为主,依次占72.77%、84.82%和61.18%,三组患者检出病原菌分布比较,差异有统计学意义（χ²=64.037,P<0.001）。鲍曼不动杆菌对头孢吡肟、头孢哌酮/舒巴坦、亚胺培南、庆大霉素、妥布霉素、左氧氟沙星、环丙沙星和复方磺胺甲口恶唑耐药率,铜绿假单胞菌对头孢哌酮/舒巴坦和亚胺培南耐药率,肺炎克雷伯菌对常用抗菌药物耐药率,三组比较差异均有统计学意义（均P<0.05）;金黄色葡萄球菌对红霉素、克林霉素和环丙沙星的耐药率比较,CAP组高于NV-HAP组（P<0.05）。结论 NV-HAP、VAP和CAP在病原菌分布及细菌耐药性方面均存在差异,在制定临床治疗方案时,要区别对待不同感染类型的肺炎。