慢阻肺合并肺部感染病原菌特点及其血清TLR4、HMGB1水平变化

Pathogens isolated from chronic obstructive pulmonary disease patients complicated with pulmonary infection and changes of serum TLR4 and HMGB1

目的分析慢性阻塞性肺疾病(COPD)合并肺部感染病原菌特点及其血清Toll样受体4(TLR4)、高迁移率族蛋白B1(HMGB1)水平变化。方法收集2016年12月-2019年12月唐山工人医院呼吸与危重症医学科诊治的616例COPD患者临床资料,根据是否合并肺部感染分为研究组416例和对照组200例。分析感染患者病原菌分布特点及其肺功能、血清TLR4、HMGB1水平变化,比较不同感染程度、不同转归患者上述指标水平差异。结果416例患者痰液标本培养共检出病原菌456株,其中革兰阴性菌282株占61.84%,以大肠埃希菌为主;革兰阳性菌123株占26.97%,以金黄色葡萄球菌为主;真菌51株占11.18%,以白假丝酵母为主;研究组一秒用力呼气容积(FEV1)、每分钟最大通气量(MVV)、最大呼气中段流量(MMF)均低于对照组(P<0.05);轻度感染组FEV1、MVV、MMF均高于中度感染组和重度感染组,血清TLR4、HMGB1水平均低于中度感染组和重度感染组(P<0.05);中度感染组FEV1、MVV、MMF均高于重度感染组,血清TLR4、HMGB1水平均低于重度感染组;死亡组患者FEV1、MVV、MMF均低于生存组,血清TLR4、HMGB1水平均高于生存组(P<0.05)。结论COPD合并肺部感染以革兰阴性菌感染为主,且COPD合并肺部感染导致患者肺功能损伤,血清TLR4、HMGB1呈高表达水平,且随感染加重肺功能损伤进一步加重,血清TLR4、HMGB1水平随之增高,临床治疗时可依据患者肺功能及血清TLR4、HMGB1水平对病情进行评估。

OBJECTIVE To investigate the pathogens isolated from chronic obstructive pulmonary disease(COPD)patients complicated with pulmonary infection and observe the changes of serum Toll-like receptor 4(TLR4)and high mobility group protein B1(HMGB1).METHODS A total of 616 COPD patients who were treated in respiratory and critical care medicine department of Tangshan Workers Hospital from Dec.2016 to Dec.2019 were enrolled in the study and divided into the study group with 416 cases and the control group with 200 cases according to the status of complication with pulmonary infection.The distribution of pathogens,lung function,serum TLR4 and HMGB1 of the patients with infection were analyzed,and the levels of above indexes were compared among the patients with different degree of infection and the patients with different treatment outcomes.RESULTS Totally 456 strains of pathogens were isolated from sputum specimens of 416 patients,282(61.84%)of which were gram-negative bacteria,123(26.97%)were gram-positive bacteria,and 51(11.18%)were fungi;Escherichia coli was dominant among the gram-negative bacteria;Staphylococcus aureus was the predominant species of the gram-positive bacteria;Candida albicans was dominant among the fungi.The forced expiratory volume in one second(FEV1),maximum ventilation volume per minute(MVV)and maximum middle expiratory flow(MMF)of the study group were significantly lower than those of the control group(P<0.05);the FEV1,MVV and MMF of the mild infection group were significantly higher than those of the moderate infection group and the severe infection group,the levels of serum TLR4 and HMGB1 of the mild infection group were significantly lower than those of the moderate infection group and the severe infection group(P<0.05);the FEV1,MVV and MMF of the moderate infection group were significantly higher than those of the severe infection group;the levels of serum TLR4 and HMGB1 of the moderate infection group were significantly lower than those of the severe infection group.The FEV1,MVV and MMF of the death group were significantly lower than those of the survival group,and the levels of serum TLR4 and HMGB1 of the death group were significantly higher than those of the survival group(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the COPD patients complicated with pulmonary infection,the complication with pulmonary infection may lead to the damage of lung function,the serum TLR4 and HMGB1 show high expression,the damage of lung function may further aggravate with the aggravation of the infection,and the levels of serum TLR4 and HMGB1 are elevated.It is necessary to evaluate the illness condition based on the lung function and levels of serum TLR4 and HMGB1.