非典型呼吸道病原体在慢性阻塞性肺病恶化中的作用

Roles of atypical respiratory pathogens in deterioration of chronic obstructive pulmonary disease

目的探讨非典型呼吸道病原体对慢性阻塞性肺病恶化的影响。方法收集我院2014年10月至2016年4月呼吸科收治的慢性阻塞性肺疾病急性加重期(AECOPD)患者422例,应用9项呼吸道联检试剂检测并分析乙型流感病毒(INFB)、腺病毒(ADV)、嗜肺军团菌(LP)、呼吸道合胞病毒(RSV)、Q热立克次体(QFR)、肺炎衣原体(CP)、甲型流感病毒(INFA)、肺炎支原体(MP)和副流感病毒(PIVS)9种非典型呼吸道病原体的检出情况,同时分析呼吸衰竭和不同AECOPD级别患者对非典型呼吸道病原体检出情况的影响。结果 422例AECOPD患者中病原体检测率为46.21%,阳性率排名为MP>INFB>ADV>PIVS1型、2型、3型>CP>RSV>INFA>LP血清1型>QFR;呼吸衰竭组患者的MP、ADV、INFB和PIVS1型、2型、3型阳性率显著高于非呼吸衰竭组,差异均有显著统计学意义(P<0.01);随着慢性阻塞性肺疾病(COPD)分级的增高,MP、ADV和INFB三种病原体检测的阳性率随之增加。结论非典型病原体在AECOPD恶化的过程中发挥了重要的作用,在临床治疗中,除针对传统病原菌的治疗,还应加强对非典型病原体的关注。

Objective To discuss the effect of atypical respiratory pathogens in deterioration of chronic obstructive pulmonary disease（COPD）. Methods From October 2014 to April 2016, 422 patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD） were detected for influenza B virus（INFB）, adenovirus（ADV）, Legionella pneumophila（LP）, respiratory syncytial virus（RSV）, Q fever rickettsia（QFR）, Chlamydia pneumonia（CP）, influenza A virus（INFA）, Mycoplasma pneumoniae（MP） and parainfluenza（PIVS） by nine respiratory joint inspection reagent. At the same time, the effects of respiratory failure and different levels of AECOPD on the examination situation of atypical respiratory pathogen were analyzed. Results In 422 patients with AECOPD, the pathogen-detection rate was 46.21%, with the positive rate ranking as MP〉INFB〉ADV〉PIVS1, 2, 3〉CP〉RSV〉INFA〉LP serum 1〉QFR. The positive rate of MP, ADV, INFB and PIVS1, 2, 3 in patients with respiratory failure were significantly higher than those without respiratory failure（P〈0.01）. With the increasing of COPD classification, the positive detection rate of MP, ADV and INFB increased. Conclusion Atypical pathogens play an important role in the deteriorating process of AECOPD, which should be also paid attention to in clinical treatment, except for the traditional pathogens.