成年人支气管扩张症急性加重期呼吸道病原谱特点以及与疾病严重度的关联分析

Respiratory pathogen spectrum in adult patients with acute exacerbation of bronchiectasis and its correlation with severity of disease

目的:分析成年人支气管扩张症在急性加重期呼吸道病原谱的特点以及其与疾病严重度的关联性。方法:2014年1月至2018年5月海口市第三人民医院收治的成年人支气管扩张症稳定期患者108例,行痰细菌培养,同时对痰液、鼻拭子常见呼吸道病毒以荧光定量聚合酶链反应(PCR)法进行检测。随访1年,对急性加重期患者再次做痰细菌培养、PCR法行病毒检测,并对比急性加重期不同疾病严重度患者呼吸道病原谱的差异。结果:随访期间发生急性加重事件53例共91例次(最多5次/例),急性加重期患者痰液病毒阳性率、鼻拭子病毒阳性率均较稳定期增高[39.6%(36/91)比15.1%(8/53)、45.1%(41/91)比9.4%(5/53)],差异有统计学意义(χ^2=8.460、13.621,P<0.05);而急性加重期患者痰液细菌培养总阳性率与稳定期比较差异无统计学意义(P>0.05)。急性加重期轻度患者(16例、23例次)、中度患者(16例、26例次)、重度患者(21例、42例次)的痰液铜绿假单胞菌阳性率[0、34.6%(9/26)、52.4%(22/42)]、痰液鼻病毒阳性率[8.7%(2/23)、3.8%(1/26)、23.8%(10/42)]比较差异有统计学意义(P<0.05)。急性加重期混合感染组C反应蛋白、白细胞介素(IL)-8水平高于阴性组、细菌组和病毒组[C反应蛋白:(45.6±23.0)mg/L比(11.2±2.7)、(32.3±10.2)、(21.3±8.0)mg/L;IL-8:(9.0±2.5)ng/L比(1.5±0.9)、(1.8±1.1)、(2.0±1.3)ng/L],差异有统计学意义(F=23.012、9.926,P<0.05);混合感染组的住院率高于阴性组、细菌组和病毒组[29.6%(8/27)比0、16.7%(4/24)、1/18],差异有统计学意义(χ^2=7.691,P<0.05)。结论:成年人支气管扩张症在急性加重期呼吸道病毒阳性率较稳定期明显增加,中、重度患者以铜绿假单胞菌及鼻病毒感染为主,轻度患者以副流感嗜血杆菌、甲型流感病毒感染为主;而细菌病毒混合感染者的全身炎性反应程度重且住院率高。

Objective To analyze the characteristics of respiratory pathogen spectrum in adult patients with acute exacerbation of bronchiectasis and its correlation with the severity of disease.Methods A total of 108 patients with stable bronchiectasis from January 2014 to May 2018 in the Third People′s Hospital of Haikou City were enrolled.Sputum bacteria were cultured and common respiratory viruses in sputum and nasal swabs were detected by fluorescence quantitative polymerase chain reaction(PCR).All bronchiectasis patients were followed up for 1 year.Sputum bacteria culture and PCR virus detection were performed again in patients with acute exacerbation,and the differences of respiratory pathogen spectrum in patients with different severity of acute exacerbation were compared.Results During the follow-up period,there were 53 cases of acute exacerbation events and a total of 91 case-times(up to 5 times per patient).The positive rates of sputum virus and nasal swab virus in patients with acute exacerbation were significantly higher than those in patients with stable period[39.6%(36/91)vs.15.1%(8/53),45.1%(41/91)vs.9.4%(5/53)],and there were significant differences(χ^2=8.460,13.621,P<0.05).However,the total positive rate of sputum bacterial culture in acute exacerbation and stable period had no significant difference(P>0.05).The positive rate of Pseudomonas aeruginosa[0,34.6%(9/26),52.4%(22/42)]and rhinovirus[8.7%(2/23),3.8%(1/26),23.8%(10/42)]in sputum among mild patients(16 cases,23 case-times),moderate patients(16 cases,26 case-times)and severe patients(21 cases,42 case-times)in acute exacerbation stage were significant differences(P<0.05).The levels of C-reactive protein(CRP)and interleukin(IL)-8 in patients in mixed infection of bacteria and viruses group in acute exacerbation stage were significantly higher than those in negative group,bacteria group and viruses group[CRP:(45.6±23.0)mg/L vs.(11.2±2.7),(32.3±10.2),(21.3±8.0)mg/L;IL-8:(9.0±2.5)ng/L vs.(1.5±0.9),(1.8±1.1),(2.0±1.3)ng/L],and there were significant differences(F=23.012,9.926,P<0.05).The hospitalization rate of patients in mixed infection of bacteria and viruses group was significantly higher than that in negative group,bacteria group and viruses group[29.6%(8/27)vs.0,16.7%(4/24),1/18],and there were significant differences(χ^2=7.691,P<0.05).Conclusions The positive rate of respiratory viruses in acute exacerbation of bronchiectasis in adults is significantly higher than that in stable stage.Pseudomonas aeruginosa and rhinovirus are the main infections in moderate and severe patients,Haemophilus parainfluenzae and influenza A virus are the main infections in mild patients,and the patients with mixed infection of bacteria and viruses have severe systemic inflammatory reaction and high hospitalization rate.