AECOPD合并支气管扩张患者病原菌分布及影响因素分析

Distribution of pathogenic bacteria and influencing factors in patients suffering AECOPD complicated with bronchiectasis

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)合并支气管扩张的病原菌分布,以及AECOPD合并支气管扩张的影响因素分析。方法选择2018年1月—2019年12月本院诊治的AECOPD患者201例作为研究对象,均行胸部高分辨率CT(HRCT)检查,按照HRCT检查结果将患者分为合并支气管扩张组(80例)和未合并支气管扩张组(121例)两组,分析AECOPD合并支气管扩张的病原菌分布,以及AECOPD合并支气管扩张的危险因素。结果共分离出69株病原菌,其中54株为革兰阴性菌、5株为革兰阳性菌、10株为真菌。经单因素分析,性别、CAT评分、慢性呼吸道症状时间、有吸烟史、有糖尿病史、有肺结核史、痰液情况、GOLD分级、FEV1、FEV1/FVC、血糖是AECOPD合并支气管扩张的影响因素(P<0.05)。经多因素二元Logistic分析,男性、高CAT评分、慢性呼吸道症状时间长、有吸烟史、有糖尿病史、痰液脓性痰和脓性黏液、高血糖是AECOPD合并支气管扩张的危险因素(P<0.05)。结论AECOPD合并支气管扩张患者的病原菌主要为革兰阴性菌,应根据病原菌分布特点合理使用抗菌药物;对于男性、高CAT评分、慢性呼吸道症状时间长、有吸烟史、有糖尿病史、痰液脓性痰和脓性黏液、高血糖的AECOPD患者,易合并支气管扩张,应早期给予治疗以减少支气管扩张的发生。

Objective To explore the distribution of pathogenic bacteria in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with bronchiectasis,and the analysis of the influencing factors of AECOPD complicated with bronchiectasis.Methods A total of 201 patients with AECOPD who were diagnosed and treated in our hospital from January 2018 to December 2019 were selected as study subjects and all of the patients underwent chest high-resolution CT(HRCT)examination.According to the results of HRCT examination,the patients were divided into bronchiectasis group(80 cases)and none bronchiectasis group(121 cases).The distribution of pathogenic bacteria in AECOPD combined with bronchiectasis and the risk factors of AECOPD combined with bronchiectasis were analyzed.Results A total of 69 pathogenic bacteria were isolated,of which 54 were gram-negative bacteria,5 were gram-positive bacteria,and 10 were fungi.According to univariate analysis,the gender,CAT score,time of chronic respiratory symptoms,history of smoking,history of diabetes,history of tuberculosis,sputum condition,GOLD grade,FEV1,FEV1/FVC,and blood glucose were the influencing factors of AECOPD complicated with bronchiectasis(P<0.05).After multivariate binary logistic analysis,the male,high CAT score,long duration of chronic respiratory symptoms,history of smoking,history of diabetes,purulent sputum and purulent mucus,and hyperglycemia were risk factors for AECOPD complicated with bronchiectasis(P<0.05).Conclusions The pathogens of AECOPD patients with bronchiectasis are mainly Gram-negative bacteria.Antibacterial drugs should be used rationally according to the distribution characteristics of pathogens.Patients with AECOPD,those of male,high CAT score,long chronic respiratory symptoms,history of smoking,history of diabetes,purulent sputum and purulent mucus and hyperglycemia,are prone to complicated with bronchiectasis,and early treatment should be given to reduce the occurrence of bronchiectasis.