作者：杨胜真1，武康宁1，蔡成森2，于健健2，邢介锋2，王珺2

单位：

1.250014山东省济南市，山东中医药大学　2.250001山东省济南市，山东中医药大学第二附属医院呼吸与危重症医学科

Units：

1.Shandong University of Traditional Chinese Medicine, Jinan 250014, China2.Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Shandong University of TraditionalChinese Medicine, Jinan 250001, China

关键词：

肺炎克雷伯菌；高黏液性肺炎克雷伯菌；毒力；基因；Meta分析

Keywords：

Klebsiella pneumoniae; Hypermucoviscous Klebsiella pneumoniae; Virulence; Genes; Meta-analysis

CLC：

R 378.99

DOI：

10.12114/j.issn.1008-5971.2022.00.240

Funds：

山东省研究生教育优质课程和专业学位研究生教学案例库项目（SDYAL20052）

摘要：

目的　荟萃分析高黏液性肺炎克雷伯菌（HMKP）毒力基因检出情况。方法　在万方数据知识服务平台、中国知网、PubMed上系统检索关于HMKP毒力基因的文献，检索时限为建库至2022年2月。根据纳入与排除标准筛选相关文献，并完成内容提取和质量评价，采用RevMan 5.4软件进行Meta分析。结果　最终共纳入文献10篇，共涉及HMKP 432株（HMKP组）、非HMKP 998株（非HMKP组）。10篇文献中，6篇的质量评为A级，4篇的质量评为B级。Meta分析结果显示，HMKP组rmpA〔RR =6.91，95%CI （4.18，11.43）〕、aerobactin〔RR =4.87，95%CI（2.12，11.15）〕、rmpA2〔RR =5.99，95%CI （3.55，10.11）〕、magA〔RR =4.24，95%CI （1.30，13.87）〕、iroN〔RR =6.41，95%CI （4.60，8.92）〕、iucA〔RR =3.61，95%CI （2.92，4.47）〕基因检出率高于非HMKP组（P ＜0.05）。HMKP组与非HMKP组mrkD〔RR =1.37，95%CI （0.99，1.91）〕、wcaG〔RR =1.97，95%CI （0.82，4.74）〕、fimH〔RR =1.16，95%CI （0.95，1.43）〕、alls〔RR =1.23，95%CI （0.57，2.65）〕、kfu〔RR =2.28，95%CI （0.95，5.45）〕、entB〔RR =1.08，95%CI （0.95，1.24）〕、ybts〔RR =1.63，95%CI （0.92，2.90）〕基因检出率比较，差异无统计学意义（P ＞0.05）。结论　与非HMKP相比，HMKP毒力基因检出率更高，这些毒力基因使HMKP的致病力更强、毒性更高，在临床上对患者的危害更大。

Abstract：

Objective　To investigate the detection of virulence genes in hypermucoviscous Klebsiella pneumoniae(HMKP) by meta-analysis. Methods　The literature on HMKP virulence genes was systematically searched on Wanfang Data,CNKI, and PubMed. The retrieval time limit was from the establishment of the database to February 2022. Relevant literaturewere screened according to the inclusion and exclusion criteria, content extraction and quality evaluation were completed, andRevMan 5.4 software was used for meta-analysis. Results　A total of 10 papers were finally included, involving a total of 432HMKP strains (HMKP group) and 998 non-HMKP strains (non-HMKP group) . Among the 10 literature, the quality evaluationof 6 literature was grade A, and the quality evaluation of 4 literature was grade B. The results of meta-analysis showed that thedetection rates of rmpA [RR =6.91, 95%CI (4.18, 11.43) ] , aerobactin [RR =4.87, 95%CI (2.12, 11.15) ] , rmpA2 [RR =5.99, 95%CI(3.55, 10.11) ] , magA [RR =4.24, 95%CI (1.30, 13.87) ] , iroN [RR =6.41, 95%CI (4.60, 8.92) ] and iucA [RR =3.61, 95%CI (2.92,4.47) ] genes in the HMKP group were higher than those in the non-HMKP group (P < 0.05) . There was no significant differencein the detection rates of mrkD [RR =1.37, 95%CI (0.99, 1.91) ] , wcaG [RR =1.97, 95%CI (0.82, 4.74) ] , fimH [RR =1.16, 95%CI(0.95, 1.43) ] , alls [RR =1.23, 95%CI (0.57, 2.65) ] , kfu [RR =2.28, 95%CI (0.95, 5.45) ] , entB [RR =1.08, 95%CI (0.95, 1.24) ]and ybts [RR =1.63, 95%CI (0.92, 2.90) ] genes between the HMKP group and the non-HMKP group (P > 0.05) . ConclusionCompared with non-HMKP, the detection rate of HMKP virulence genes is higher, and these virulence genes make HMKP morevirulent, more toxic, and more harmful to patients clinically.

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