下呼吸道细菌定植对老年COPD稳定期患者预后与转归的影响

doi:10.3969/j.issn.1671-7171.2018.06.012

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要【目的】探讨下呼吸道细菌定植( lower airway bacterial colonization, LABC)对老年慢性阻塞性肺疾病(COPD) 稳定期患者预后与转归的影响。【方法】选择2016年5月至2017年8月本院诊治的老年稳定期COPD患者85例,对其痰液进行细菌学培养。根据是否发生LABC分为定植组(53例)和非定植组(32例),比较两组患者血清炎性因子水平、发作情况、肺功能分级等指标。【结果】85例老年COPD稳定期患者发生LABC 53例,发生率为62.35%;定植细菌主要是流感嗜血杆菌(30.19%)、肺炎链球菌(16.98%)、卡他莫拉菌(13.21%)等,定植菌株百分比与定植量基本呈正相关;定植组血清白细胞介素-8(IL-8)、超敏C反应蛋白(hs-CRP)水平、每年平均急性发作次数、合并下呼吸道感染均高于非定植组(t/χ²为9.615, 7.487, 5.817, 13.833,均P<0.05),肺功能分级极重度率为18.87%,明显高于非定植组3.13%(χ²=4.389,P<0.05)。【结论】老年COPD稳定期患者下呼吸道细菌定植发生率高,细菌定植可加重气道炎性反应,增加急性发作及下呼吸道感染率,降低肺功能,严重影响患者的预后与转归。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李有军
	毛建川

关键词 ：细菌感染/并发症, 肺疾病, 慢性阻塞性/并发症, 老年人

Abstract：【Objective】To investigate the effect of low airway bacterial colonization (LABC) on the outcomes and prognosis of senile patients with chronic obstructive pulmonary disease (COPD) at stable stage, and to provide reference for assessing the severity of disease and treatment. 【Methods】A total of 85 elderly patients with stable COPD from May 2016 to August 2017 were selected as the study subjects and quantitative bacterial cultures were performed on their induced sputum. According to whether or not LABC occurred, they were divided into colonization group (53 cases) and non-colonization group (32 cases). The levels of serum inflammatory factors, symptoms, and lung function grading were compared between the two groups. 【Results】A total of 83 elderly patients with stable COPD contained 53 cases of LABC; the incidence rate was 62.35%. The main bacteria were haemophilus influenzae (30.19%), Streptococcus pneumoniae (16.98%) and Moraxella catarrhalis (13.21%). The proportion of colonizing strains and the amount of colonization were positively correlated. The levels of serum interleukin-8 (IL-8), high-sensitivity C-reactive protein (hs-CRP), the average number of acute exacerbations per year, and the rate of combined lower respiratory tract infection were higher in the colonization group than in the non-colonization group (t/χ²=9.615, 7.487, 5.817, 13.833,P<0.05, P<0.01). The extremely severe rate of lung function classification was 18.87%, significantly higher than that of the non-colonization group (3.13%) (χ²=4.389,P<0.05). 【Conclusion】The incidence of low airway bacterial colonization of elderly patients with COPD at the stable stage is high. Bacterial colonization can aggravate the airway inflammatory reaction, increase the incidence of acute attacks and lower respiratory infection, reduce lung function, and seriously affect the outcomes and prognosis of patients.

Key words： BacterialInfections/CO PulmonaryDisease,ChronicObstructive/CO Aged

收稿日期: 2018-05-10

PACS:

R563.1

引用本文:

李有军, 毛建川. 下呼吸道细菌定植对老年COPD稳定期患者预后与转归的影响[J]. 医学临床研究, 2018, 35(6): 1076-1078.
LI You-jun, MAO Jian-chuan. Effect of Low Airway Bacterial Colonization on the Outcomes and Prognosis of Elderly COPD Patients at Stable Stage. JOURNAL OF CLINICAL RESEARCH, 2018, 35(6): 1076-1078.

链接本文:

http://www.jcr.net.cn/CN/10.3969/j.issn.1671-7171.2018.06.012 或 http://www.jcr.net.cn/CN/Y2018/V35/I6/1076

[1] 陈学东,魏俊,任君清,等.布地奈德治疗慢性性肺疾病急性加重期临床观察[J].海南医学院学报,2016,22(11):1066-1068.
[2] Shukla SD.Platelet activating factor receptor: gateway for bacterial chronic airway infection in chronic obstructive pulmonary disease and potential therapeutic target [J].Expert Rev Respir Med,2015, 9(4): 473-485.
[3] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中国医学前沿杂志(电子版),2014,6(2):67-80.
[4] 蒋兆强,陈钧强,张敏,等.肺功能损伤分级及临床实践指南循证评价及分级指标优化研究[J].中国职业医学,2013,40(1):37-39.
[5] Sibila O, Garcia-Bellmunt L, Giner J, et al. Airway mucin 2 is decreased in patients with severe chronic obstructive pulmonary disease with bacterial colonization [J].Ann Am Thorac Soc,2016, 13(5): 636-642.
[6] 姚剑坤.COPD有创机械通气患者下呼吸道病原学及耐药性分析[J].医学临床研究,2016, 33(5):865-869.
[7] Tufvesson E,Markstad H,Bozovic G,et al.Inflammation and chronic colonization of Haemophilus influenzae in sputum in COPD patients related to the degree of emphysema and bronchiectasis in high-resolution computed tomography[J].Int J Chron Obstruct Pulmon Dis,2017, 1(12):3211-3219.
[8] Fruchter O, Rosengarten D, Goldberg E, et al. Airway bacterial colonization and serum C-reactive protein are associated with chronic obstructive pulmonary disease exacerbation following bronchoscopic lung volume reduction [J].Clin Respir J,2016, 10(2): 239-245.[9] 开赛尔?艾则孜,肖开提?买买提依明,杨晓红.氨溴索对AECOPD患者肺功能、氧化应激和炎症因子的影响[J].海南医学院学报,2016,22(9):754-757.
[10] Ostridge K, Williams NP, Kim V, et al. Relationship of CT-quantified emphysema, small airways disease and bronchial wall dimensions with physiological, inflammatory and infective measures in COPD[J].Respir Res,2018,19(1):31-43.
[11] 温庆辉,高元妹,黎凤英,等.下呼吸道细菌培养在慢性阻塞性肺疾病急性加重期的临床价值[J].重庆医学,2014,43(1):118-120.
[12] 梁权,樊启财,陈双杰.下呼吸道细菌定植对稳定期COPD患者免疫细胞和炎性因子水平的影响分析[J].内科,2017,12(2):214-215.
[13] 石明,杨中卫,李威,等.下呼吸道细菌定植对稳定期COPD患者炎性因子及免疫细胞水平的影响[J].医学综述,2016,22(8):1585-1587.
[14] 周慧霞,加尔肯?拉斯拜,白云峰,等.慢性阻塞性肺疾病长期随访中肺功能的变化及影响因素[J].医学临床研究,2017,34(8):1640-1642.
[15] Trudzinski FC, Seiler F, Wilkens H ,et al.Microbiological airway colonization in COPD patients with severe emphysema undergoing endoscopic lung volume reduction[J].Int J Chron Obstruct Pulmon Dis,2017,19(13):29-35.
[16] 温庆辉,高元妹,黎凤英,等.慢性阻塞性肺疾病患者下呼吸道细菌定植与急性加重的相关性分析[J].广东医学院学报,2015,33(3):292-295.
[17] 黄锦浪,罗永军,黄潘文.稳定期COPD患者下呼吸道细菌定植对免疫功能、气道功能及炎症程度的影响[J].海南医学院学报,2016,22(24):2959-2962.
[18] 王慎临,杨朝,张丽萍.维生素D与COPD患者下呼吸道细菌定植及痰相关炎症因子关系的研究[J].宁夏医学杂志,2017,39(11):964-967.