从慢性阻塞性肺疾病全球倡议治疗目标谈慢性阻塞性肺疾病急性加重的抗菌治疗

Antimicrobial therapy for acute exacerbation of chronic obstructive pulmonary disease based on therapeutic target of GOLD

慢性阻塞性肺疾病(慢阻肺)是一种可防可治的常见疾病,其特征为持续存在的呼吸道症状和气流受限,通常由有害颗粒或气体暴露引起的气道和(或)肺泡异常而导致。我国是慢阻肺高患病率、高致残率、高负担国家。慢阻肺急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)是指慢阻肺自然病程中出现的急性事件,特征为呼吸困难、咳嗽和(或)咳痰加重,超越了日常状况的变化,且提示需要改变常规用药。慢阻肺急性加重是增加医疗负担和导致死亡的主要因素,慢阻肺急性加重频繁发作会对患者的生活质量、疾病进展、死亡率、医疗费用产生重大影响。感染是导致AECOPD最常见诱因,对急性加重患者选择合适的抗菌药物,对治疗效果和预后起着至关重要的作用。2019年慢性阻塞性肺疾病全球倡议(global initiative for chronic obstructive lung disease,GOLD)报告明确提出慢阻肺急性加重期的治疗目标是使本次急性加重影响最小化,并预防未来急性加重的发生。本文依据近年来循证医学证据,从GOLD治疗目标谈抗菌药物在慢阻肺急性加重治疗中的应用,以便优化临床对AECOPD的管理。

Chronic obstructive pulmonary disease(COPD) is a common preventable and treatable disease characterized by continuous respiratory symptoms and airway limitation.It is usually caused by airway and/or alveolar abnormality due to exposure to harmful particles or gas.The incidence and disability rate of COPD are high in China,making it a heavy burden.Acute exacerbation of COPD(AECOPD) refers to the acute event in the development of the disease,characterized by the exaggeration of dyspnea,cough and/or phlegm.The situation gets worse than general condition,and changes in regular medications are indicated in the situation.AECOPD adds to the medical burden and is the main factor leading to mortality,and frequent recurrence of AECOPD exerts major influence on the quality of life,disease progression,mortality and medical costs in patients.The 2019 global initiative for chronic obstructive lung disease(GOLD) demonstrated that the therapeutic target is to minimize the influence of AECOPD and to prevent further recurrence.In this review,the application of antibacterial agents in patients with AECOPD was discussed based on recent evidence,aiming at optimizing the management on AECOPD.