老年COPD合并肺部感染患者肠道菌群分布及其与血清IL-6、SAA、PCT的相关性

Distribution of Intestinal Flora in Elderly Patients with COPD and Pulmonary Infection and Its Correlation with Serum IL-6,SAA and PCT

目的 观察老年慢性阻塞性肺病(COPD)合并肺部感染患者肠道菌群分布情况,并分析其与血清白介素6(IL-6)、血清淀粉样蛋白A(SAA)、降钙素原(PCT)表达水平的关系。方法 选取华西广安医院225例老年COPD患者,其中168例合并肺部感染(肺部感染组),57例无肺部感染(无肺部感染组),检测其肠道菌群分布及血清IL-6、SAA、PCT,进行相关性分析,并采用Logistic回归模型分析老年COPD合并肺部感染相关危险因素。结果 2组肠道中梭杆菌(t=0.452,P=0.652)、乳杆菌(t=1.444,P=0.150)、拟杆菌(t=1.007,P=0.315)以及肠球菌(t=1.335,P=0.183)数目无显著差异;肺部感染组双歧杆菌明显少于无肺部感染组(t=9.293,P<0.001),肠杆菌明显多于无肺部感染组(t=11.400,P<0.001);2组在吸烟史(χ^(2)=23.705,P<0.001)、糖尿病(χ^(2)=21.500,P<0.001)、血清IL-6(t=34.106,P<0.001)、SAA(t=33.653,P<0.001)、PCT(t=41.377,P<0.001)表达水平等方面的比较有统计学意义;IL-6、SAA、PCT与双歧杆菌呈负相关(r=-0.542、-0.517、-0.493,P均<0.001),与肠杆菌呈正相关(r=0.476、0.603、0.578,P均<0.001);Logistic回归分析显示,吸烟史、糖尿病、IL-6、SAA、PCT水平升高属于老年COPD合并肺部感染独立危险因素(P均<0.001)。结论 老年COPD合并肺部感染患者肠道菌群失衡主要表现为双歧杆菌减少与肠杆菌增多,均与血清IL-6、SAA、PCT密切相关,这些因子水平升高为肺部感染主要危险因素。

Objective To observe the distribution of intestinal flora in elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection,and to analyze its relationship with serum interleukin 6(IL-6),serum amyloid A(SAA),and procalcitonin(PCT)levels.Methods 225elderly patients with COPD were enrolled in this study,including 168cases with pulmonary infection(pulmonary infection group)and 57cases without pulmonary infection(non-pulmonary infection group).The distribution of intestinal flora,serum IL-6,SAA and PCT were detected,and correlation analysis was conducted.Logistic regression model was used to analyze the risk factors for pulmonary infection in elderly patients with COPD.Results Fusobacterium count(t=0.452,P=0.652),Lactobacillus count(t=1.444,P=0.150),Bacteroides count(t=1.007,P=0.315),and Enterococcus count(t=1.335,P=0.183)showed no significant differences between the two groups(P>0.05).Bifidobacteria in intestines of the pulmonary infection group was significantly less than that in intestines of the non-pulmonary infection group(t=9.293,P<0.001),and Enterobacteria was significant more than that in intestines of the non-pulmonary infection group(t=11.400,P<0.001).There were statistically significant differences in smoking history(χ^(2)=23.705,P<0.001),diabetes(χ^(2)=21.500,P<0.001),serum IL-6(t=34.106,P<0.001),SAA(t=33.653,P<0.001)and PCT(t=41.377,P<0.001)between the two groups.IL-6,SAA,and PCT were negatively correlated with Bifidobacteria(r=-0.542,-0.517,-0.493,P<0.001),and positively correlated with Enterobacteria(r=0.476,0.603,0.578,P<0.001).Logistic regression analysis showed that smoking history,diabetes,IL-6,SAA and PCT levels were independent risk factors for pulmonary infection in elderly patients with COPD(all P<0.001).Conclusion Imbalance of intestinal flora in elderly patients with COPD and pulmonary infection mainly manifests as decreased Bifidobacteria and increased Enterobacteria which are closely related to serum IL-6,SAA and PCT.Elevated levels of these factors are main risk factors for pulmonary infection.