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

Analysis on correlation between bacterial colonization of the lower respiratory tract and acute exacerbation of chronic obstructive pulmonary disease

目的分析下呼吸道细菌定植(LABC)与稳定期慢性阻塞性肺疾病(COPD)急性加重的相关性,为此类疾病感染的预防、控制及转归提供依据。方法对东莞市人民医院呼吸科2009年7月至2014年6月收治的发生急性加重的COPD住院患者的资料进行回顾性分析,并对培养出来的定植菌及致病菌进行比对检测、同源性分析及相关指标检测。结果呼吸科COPD稳定期及慢性阻塞性肺疾病急性加重期(AECOPD)的同一患者培养得出的细菌以嗜血杆菌属、肺炎链球菌、卡他莫拉菌及铜绿假单胞菌为主,细菌同源性约为31.7%(39/123)。与COPD稳定期相比,AECOPD患者的IL-8水平明显升高(P<0.01)。与无细菌定植组比较,有细菌定植组AECOPD患者的下呼吸道细菌感染率明显升高(P<0.05)。结论部分COPD稳定期患者存在LABC,在一定程度上LABC可导致COPD急性加重;而稳定期COPD气道炎症与是否发生LABC及IL-8水平相关。

Objective To analyze the correlation between bacterial colonization of the lower respiratory tract（LABC） and acute exacerbation of chronic obstructive pulmonary disease（COPD） in stable stage, so as to provide a basis for the prevention of such diseases, control and prognosis. MethodsClinical data of the patients with acute exacerbation of COPD admitted to Department of Respiration of Dongguan People＇s Hospital from July 2009 to June 2014 were retrospectively analyzed. The colonized bacteria cultured and pathogenic bacteria underwent comparison testing, homology analysis and testing of relevant indicators. ResultsThe bacteria cultured from the same patient with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） in stable stage were mainly haemophilus genera, streptococcus pneumoniae and moraxella catarrhalis, and pseudomonas aeruginosa bacteria, and the bacteria homology was about 31.7%（39/123）. Compared with COPD in stable stage, the patient had a significantly increased level of IL-8（P〈0.01）. Compared with the group without bacterial colonization, the group with bacterial colonization had a significantly increased bacterial infection rate at lower respiratory tract（P〈0.05）. Conclusion Part of the patients with COPD in stable stage had LABC, which to some extent can cause acute exacerbation of COPD. The airway inflammation of COPD in stable stage is relevant to the occurrence of LABC and IL-8 level.