成人支气管扩张症病原菌分布及咯血原因分析

Distribution of pathogenic bacteria and causes of hemoptysis in adult bronchiectasis

目的探讨成人支气管扩张症患者病原菌分布特征,及咯血与支气管扩张类型及部位之间的关系。方法回顾性分析2012年6月至2017年6月在我院呼吸内科确诊的196例支气管扩张症患者的临床表现、痰培养结果、影像学特征等资料。结果痰培养致病菌以G-菌为主(64.5%),真菌占29.0%,G-菌以铜绿假单胞菌最多见(65.0%);有并发症组致病菌检出率明显高于单纯组及有合并症组(P<0.05);咯血的支气管扩张症患者胸部CT或HRCT支气管扩张形态学改变中,囊状型最为常见(71.6%),其次为混合型(19.8%);病变部位以多肺叶、两肺病变为主,以左下肺最为常见(63.0%),其次是右下肺(54.3%)。结论成人支气管扩张症患者痰培养致病菌以G-菌为主,铜绿假单胞菌最多见,但真菌不易忽视,应依据痰培养+药敏结果,有针对性选择抗菌药物治疗。囊状型支气管扩张患者可能更易出现咯血,其相对临床状况重,预后较差,需引起临床重视。

Objective To investigate the distribution of pathogenic bacteria and the relationship between hemoptysis and bronchiectasis type and site in adult bronchiectasis.Methods The clinical data of 196 patients with bronchiectasis were retrospectively analyzed in our hospital from June 2012 to June 2017,including the clinical manifestations,sputum culture results,and imaging features.Results The pathogens of sputum culture were mainly gram negative bacteria(64.5%),and fungi accounted for 29%.Pseudomonas aeruginosa were the most commonly identified pathogens in gram negative bacteria(65.0%).The pathogen detection rate of the complication group was higher than that of the simple group and the comorbidity group(P<0.05).In patients with hemoptysis,the type of cystic change was the most common(71.6%)in CT or HRCT,followed by mixed type(19.8%).The lesions were mainly in multi lobar and two pulmonary lesions,the left lower lobar was the most common(63.0%),followed by right lower lobar(54.3%).Conclusion In adult bronchiectasis,the main pathogens of sputum culture are gram negative bacteria,most of which are pseudomonas aeruginosa,but the fungus is not easy to ignore,so antibiotics should be selected according to the results of sputum culture and susceptibility test.Cystic bronchiectasis may be more prone to hemoptysis,its relative clinical condition is heavy and prognosis is poor,which should be paid more attention.