家庭无创通气老年稳定期COPD患者下呼吸道细菌定值情况及其对气道炎症反应的影响

BACTERIAL COLONIZATION OF LOWER RESPIRATORY TRACT AND ITS INFLUENCES ON AIRWAY INFLAMMATION RESPONSE IN 80 ELDERLY PATIENTS WITH STABLE COPD UNDERGOING FAMILY NON-INVASIVE VENTILATION

目的 探讨80例家庭无创通气慢性阻塞性肺疾病(COPD)稳定期老年患者下呼吸道细菌定值情况及其与气道炎症的关系。方法 选取本院2019年2月—2021年2月80例进行家庭无创通气的COPD稳定期老年患者,根据痰液培养细菌定植结果,分为定植组(n=44)与无定植组(n=36),检测患者血清中炎性因子[白介素6(IL-6)、白介素8(IL-8)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)]水平以及外周血外周血中Th1细胞及Th2细胞的含量,测定肺功能指标[第1秒用力肺活量(FEV1)、FEV1占预计值%、第1秒用力呼气量占所有呼气量的比例(FEV1/FVC)]水平,分析痰液半定量培养结果与气道炎性反应与肺功能的相关性。结果 80例家庭无创通气COPD稳定期老年患者共有44例检测出下呼吸道细菌定植,共检测出致病菌52株,主要为流感嗜血杆菌、肺炎链球菌、副流感嗜血杆菌、卡他拉莫菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、鲍曼不动杆菌,分别占30.77%、15.38%、13.46%、11.54%、9.62%、7.69%、7.69%、3.85%;定植组患者炎性细胞因子痰液IL-6、IL-8以及血清IL-8、TNF-α、hs-CRP水平高于无定植组(P<0.05);定植组外周血Th1、Th1/Th2细胞水平低于无定植组,Th2细胞水平高于无定植组(P <0.05);Spearman相关性分析结果显示,痰液细菌半定量培养结果与炎性因子痰液IL-6、IL-8以及血清IL-8、TNF-α、hs-CRP水平呈现正相关(r=0.509、0.602、0.413、0.369、0.402,均P<0.05);痰液细菌半定量培养结果与外周血Th1/Th2水平呈现负相关(r=-0.481,P<0.05);定植组患者肺功能指标FEV1、FEV1占预计值百分比水平低于无定植组,FEV1/FVC水平高于无定植组(P<0.05);Spearman相关性分析结果显示,痰液细菌半定量培养结果与肺功能指标FEV1、FEV1占预计值%呈负相关(r=-0.509、-0.381,均P<0.05);痰液细菌半定量培养结果与肺功能指标FEV1/FVC呈正相关(r=0.405,P<0.05)。结论 家庭无创通气COPD稳定期老年患者下呼吸道细菌定植可导致气道炎症反应,破坏免疫系统正常功能,降低肺功能水平。

Objective To explore the bacterial colonization of lower respiratory tract(LRT) and its relationship with airway inflammation in the eighty elderly patients with stable chronic obstructive pulmonary disease(COPD) undergoing family non-invasive ventilation.Methods A total of eight elderly patients with stable COPD undergoing family non-invasive ventilation in the hospital were enrolled between February 2019 and February 2021.According to bacterial colonization results of sputum culture, they were divided into colonization group(n=44) and non-colonization group(n=36).The levels of serum inflammatory factors[interleukin 6(IL-6),interleukin 8(IL-8),tumor necrosis factor α(TNF-α),high-sensitivity C-reactive protein(hs-CRP)],peripheral blood Th1 and Th2 were detected.The levels of pulmonary function indexes[forced expiratory volume in 1 second(FEV1),FEV1 as a percentage of predictive value(FEV1%),FEV1/forced vital capacity(FEV1/FVC)]were detected.The correlation between sputum semi-quantitative culture results and airway inflammation response, pulmonary function was analyzed.Results Among the 80 elderly patients with stable COPD undergoing family non-invasive ventilation, there were 44 cases with bacterial colonization of LRT.There were 52 strains of pathogens, mainly on Haemophilus influenzae, Streptococcus pneumoniae, Haemophilus parainfluenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus and Acinetobacter baumannii(30.77%,15.38%,13.46%,11.54%,9.62%,7.69%,7.69%,3.85%).The levels of IL-6 and IL-8 in sputum, IL-8,TNF-α and hs-CRP in serum in colonization group were higher than those in non-colonization group(P<0.05).The levels of peripheral blood Th1 and Th1/Th2 in colonization group were lower than those in non-colonization group, while Th2 level was higher than that in non-colonization group(P<0.05).The results of Spearman correlation analysis showed that semi-quantitative culture results of sputum bacteria were positively correlated with levels of IL-6 and IL-8 in sputum, IL-8,TNF-α and hs-CRP in serum(r=0.509,0.602,0.413,0.369,0.402,P<0.05),while negatively correlated with peripheral blood Th1/Th2(r=-0.481,P<0.05).FEV1 and FEV1% in colonization group were lower than those in non-colonization group, while FEV1/FVC was higher than that in non-colonization group(P<0.05).The results of Spearman correlation analysis showed that semi-quantitative culture results of sputum bacteria were negatively correlated with FEV1 and FEV1%(r=-0.509,-0.381,P<0.05),while positively correlated with FEV1/FVC(r=0.405,P<0.05).Conclusion Bacterial colonization of LRT in elderly patients with stable COPD undergoing family non-invasive ventilation will lead to airway inflammation response, disrupt normal immune system function and decrease pulmonary function level.