慢性阻塞性肺疾病急性加重与细菌感染的相关性研究

Study on the relationship between airway bacterial infections and acute exacerbations in patients with chronic obstructive pulmonary disease

目的 观察慢性阻塞性肺疾病（COPD）急性加重期（AECOPD）患者气道细菌感染情况。方法 前瞻性研究门诊、急诊和住院AECOPD患者130例，根据症状和肺功能情况分组，进行痰培养，研究不同型、不同严重程度的AECOPD之间细菌阳性率的差异。结果 50例患者细菌培养阳性（38．5％），共鉴定出致病菌60株，主要为副流感嗜血杆菌（20／60）、流感嗜血杆菌（10／60）和肺炎链球菌（5／60），1型AECOPD患者痰菌阳性率（55．0％）比2型（38．3％）、3型（18．5％）患者高（P=0．01），随着AECOPD肺功能下降程度增加，痰菌阳性率上升（P〈0．02）。结论 1型AECOPD患者痰菌阳性率最高，副流感嗜血杆菌是导致AECOPD的重要病原菌之一，痰菌阳性率与COPD严重程度相关。

Objective The purpose of this study was to observe the bacterial infections of respiratory tract in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods 130 patients with AECOPD in outpatient department, emergency room or in wards were studied prospectively. Patients were divided into different groups according to both Anthonisen＇s classification and their lung function status. Sputum were cultured together with bacteria positive rate and types of AECOPD as well as the damage degree of lung function were analyzed. Results Of 130 sputum samples, 50 showed positive through culture （38.5%） and 60 strains of pathogens were isolated. Predominant pathogens isolated would include Haemophilus parainfluenzae （ 20/60 ）, Streptococcus pneumoniae （ 5/60 ） and Haemophilus influenzae （10/60）. Positive rate of bacterial culture in type 1 AECOPD was 55.0 % , higher than those of type 2（38.3 % ） and type 3（ 18.5 % ） （ P = 0.01） and was increasing with the decrease of lung function of patients with AECOPD（ P 〈 0.02）. Conclusion Positive rate of bacterial culture in patients of type 1 AECOPD was the highest one. Haemophilus parainfluenzae was one of the most important pathogens in AECOPD. There seemed a correlation between positive result of bacterial culture and the severity of COPD.