急性加重期慢性阻塞性肺疾病患者的细菌学构成及其与肺功能的关系

Bacteriological composition and its relationship with pulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨急性加重期慢性阻塞性肺疾病(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者的细菌学构成及其与肺功能的关系。方法回顾性分析2019年1月至2020年12月海南医学院第二附属医院呼吸内科收治的356例AECOPD患者的临床资料,统计痰培养、肺功能结果,根据肺功能分级分成Ⅱ、Ⅲ、Ⅳ级,分析细菌学与肺功能的相关性。结果356例AECOPD患者中培养出细菌133株:鲍曼不动杆菌32株、铜绿假单胞菌31株、肺炎克雷伯杆菌25株、肺炎链球菌11株、金黄色葡萄球菌2株。肺功能Ⅱ、Ⅲ、Ⅳ级患者痰培养细菌阳性率分别为20.93%、35.14%、42.62%。肺功能Ⅳ级患者革兰阴性菌的感染率较Ⅱ级高,差异有统计学意义(P<0.05),革兰阳性菌与肺功能差异无统计学意义(P>0.05)。结论AECOPD患者的痰细菌学培养主要是革兰阴性菌,依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌,还有少量革兰阳性菌。AECOPD患者肺功能越差越容易感染致病菌,肺功能Ⅳ级患者感染鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌概率更高。

Objective To investigate the bacteriological composition of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and its relationship with lung function.Methods The case data of 356 patients with AECOPD admitted to the Department of Respiratory Medicine,the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2020 was retrospectived study.The results of sputum culture and lung function were analyzed.According to the pulmonary function grades,patients were divided into gradeⅡ,ⅢandⅣ,the correlation between pathogenic bacteria and lung function were analyzed.Results A total of 356 patients,133 bacterial strains were cultured.Among these bacterial strains,there were 32 strains of acinetobacter baumanni,31 strains of pseudomonas aeruginosa,25 strains of klebsiella bacillus,11 strains of streptococcal pneumoniae pneumonia,and 2 strains of staphylococcus aureus.The positive rate of bacteria in sputum culture was 20.93%,35.14%and 42.62%in patients with gradeⅡ,ⅢandⅣlung function,respectively.The infection rate of gram-negative bacteria in gradeⅣgroup was higher than that in gradeⅡgroup,the difference was statistically significant(P<0.05),but there was no significant difference between gram-negative bacteria and lung function(P>0.05).Conclusion Sputum bacteriological culture of patients with AECOPD were mainly composed of gram-negative bacteria,followed by acinetobacter baumannii,pseudomonas aeruginosa,klebsiella bacillus and a small number of gram-negative bacteria.The worse the lung function of patients with AECOPD,the more likely they were to be infected with pathogenic bacteria.Patients with pulmonary function gradeⅣwere more likely to be infected with acinetobacter baumannii,pseudomonas aeruginosa and klebsiella bacillus.