慢性阻塞性肺疾病急性加重患者中病原体的检测分析

Detection and Analysis of Pathogens in Patients with Acute Exacerbation Underlying Chronic Obstructive Pulmonary Disease

目的探究呼吸道病原体在慢性阻塞性肺疾病急性加重患者中的感染情况。方法回顾性分析2015年5月~2016年4月住院478例慢性阻塞性肺疾病急性加重患者,应用间接免疫荧光法(IFA)检测病毒(流感病毒A/B、副流感病毒、呼吸道合胞病毒、腺病毒)和非典型病原体(嗜肺军团菌、肺炎支原体、肺炎衣原体)8种呼吸道病原体Ig M抗体,并进行痰培养细菌学鉴定。结果患者呼吸道病原体检测总感染率为78.0%(373/478),病原体分类感染组合以单类病原体感染为主占41.2%(197/478),病毒类感染居多(占58.4%),病原体多重感染占58.7%(219/373),较单一感染多,其中流感病毒B、肺炎支原体、嗜肺军团菌、流感病毒A和念珠菌位于总阳性率和单一病原体感染者的前列;感染者中男性占54.7%(204/478),男性以单一感染为主63.0%(97/154),女性以2个或以上病原体的多重感染为主51.1%(112/219),病毒和非典型病原体的感染在性别间差异均有统计学意义(χ~2=4.7,P=0.03;χ~2=19.83,P=0);真菌在不同季度间感染率的差异有统计学意义(χ~2=11.85,P=0.008),其余病原体在不同季度间的差异均无统计学意义。结论本研究中慢性阻塞性肺疾病急性加重(AECOPD)患者的病原体感染主要由病毒和非典型病原体引起,以流感病毒B、肺炎支原体、流感病毒A、嗜肺军团菌和念珠菌的单一或混合感染常见。

Objective To detect respiratory pathogens in patients with acute exacerbation underlying chronic obstructive pulmonary disease （AECOPD） so as to provide evidences for clinical treatments. Methods A retrospective analysis was performed in the hospital from May 2015 to April 2016. 478 cases of AECOPD were examined for IgM antibodies by IFA, and pathogens by sputum culture for influenza virus A/B, para influenza virus, respiratory syncytial virus, adenovirus and atypical pathogens （ Legionella pneumophila, Mycoplasma pneumonia, and Chlamydia pneumonia） . Results The overall positive rate of pathogens was 78.0% （ 373/478） , single species infection accountedfor 41.2% （ 197/478） , viral infection accounted for 58.4%, and multiple pathogen infections accounted for 58.7%（ 219/373 ） . Among them, influenza virus B, M. pneumonia and L. pneumophilia, influenza virus A and Candida infection dominates both in total prevalence and single species pathogen infection. Males had a higher positive rate of 54.7% （ 204/478） than females （45.3%,169/478） （ χ2=4.06 , P=0 .044 ） Virus and atypical pathogen infectionsvaried in gender （χ2=4.7,P=0.03, χ2= 19.83, P= 0 ） ; fungus infection rate changedwith seasons （χ2=11.85,P=0.008 ） . Conclusions The causative agents in AE-COPD mainly are comprised of viruses and atypical pathogens, influenza virus B, M. pneumonia, influenza virus A , L. pneumophila and Candida, single species or mixed infections are common.