慢阻肺合并下呼吸道感染患者痰液病原菌分布及血清SAA水平变化分析

Analysis of the distribution characteristics of pathogenic bacteria and changes in serum SAA levels in sputum samples of patients with chronic obstructive pulmonary disease and lower respiratory tract infection

目的分析慢阻肺呼吸道感染患者痰液病原菌分布情况及血清SAA水平变化特点。方法选取2020年3月至2023年3月,本院接诊的260例慢阻肺合并下呼吸道感染患者为研究对象,选取同期未发生下呼吸道感染的90例慢阻肺患者为未感染组,同期体检健康的100例为健康对照组。下呼吸道感染患者于入院次日清晨空腹采集痰标本,培养分离后,用全自动细菌鉴定仪及配套鉴定卡鉴定病原菌。将260例合并下呼吸道感染患者随机分为观察组与对照组,两组患者均进行基础治疗。对照组给予头孢哌酮/舒巴坦钠注射液静脉滴注,观察组患者在对照组的基础上加用莫西沙星。用药一周后,对比两组患者临床疗效及细菌清除率。患者入院当天及第3 d,分别采集静脉血,健康组患者体检时采集静脉血。采用酶联免疫吸附法(ELISA)检测血清SAA水平。并对下呼吸道感染患者进行感染严重程度评估,分析下呼吸道感染患者血清SAA水平与感染严重程度的相关性。结果共检出病原菌260株。57.31%为革兰阴性菌149株,主要为肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌。30.38%为革兰阳性菌,主要为肺炎链球菌、金黄色葡萄球菌。12.31%为真菌,主要为白假丝酵母菌。对比不同年龄组患者病原菌分布特点,老年组革兰阴性菌占63.89%,非老年组占49.14%,老年组革兰阳性菌占22.22%,非老年组占40.52%,差异有统计学意义(P<0.05)。老年组真菌占13.89%,非老年组占10.34%,差异无统计学意义(P>0.05)。长病程组革兰阴性菌占67.35%,短病程组占51.23%,长病程组革兰阳性菌占20.41%,短病程组占36.42%,差异有统计学意义(P<0.05)。长病程组真菌占12.24%,短病程组占12.35%,差异无统计学意义(P>0.05)。经过7 d治疗后,观察组患者痊愈率为52.31%,总有效率为89.23%。对照组患者痊愈率为44.62%,总有效率为74.62%,总有效率差异有统计学意义(P<0.05)。观察组细菌清除率为90.77%,对照组为80.77%,差异有统计学意义(P<0.05)。合并下呼吸道感染组患者入院时血清SAA水平为(85.09±17.58)mg/L,未感染组为(52.72±11.13)mg/L,健康对照组为(11.97±0.29)mg/L,差异有统计学意义(P<0.05)。慢阻肺合并下呼吸道感染患者入院时CPIS为(8.01±0.72)分,入院第3 d CPIS为(8.36±0.68)分。入院时CPIS分与血清SAA水平、入院第3 d CPIS分与血清SAA水平均呈正相关。结论慢阻肺合并下呼吸道感染患者,病原菌主要为革兰阴性菌。不同年龄、不同病程组患者的革兰阴性菌、革兰阳性菌构成比对比差异具有统计学意义。头孢哌酮/舒巴坦联合莫西沙星治疗慢阻肺合并下呼吸道感染的临床疗效及细菌清除效果较好。感染严重程度与血清SAA水平具有强相关性。

Objective To analyze the distribution of pathogenic bacteria and changes in serum SAA levels in sputum samples of patients with chronic obstructive pulmonary disease and lower respiratory tract infection.Methods 260 patients with chronic obstructive pulmonary disease(COPD)complicated with lower respiratory tract infection who were admitted to our hospital from March 2020 to March 2023 were selected as the study subjects.90 COPD patients who did not experience lower respiratory tract infection during the same period were selected as the uninfected group,and 100 healthy individuals with normal physical examination in our hospital during the same period were selected as the healthy control group.On the morning after admission,patients with lower respiratory tract infection were collected sputum samples on an empty stomach for cultivation and isolation.The pathogen was identified by a fully automated bacterial identification instrument and a matching identification card.260 patients with lower respiratory tract infection were randomly divided into an observation group and a control group,both groups receiving basic treatment.The control group received intravenous infusion of cefoperazone/sulbactam sodium injection,while the observation group received moxifloxacin in addition to the control group.After one week of medication,the clinical efficacy and bacterial clearance rate between the two groups of patients were compared.On the day of patient admission and the third day,venous blood was collected separately,while in the healthy group,venous blood was collected during physical examination.Serum SAA levels were detected by enzyme-linked immunosorbent assay(ELISA).The severity of infection in patients with lower respiratory tract infection was evaluated,and the correlation between serum SAA levels and infection severity were analyzed in patients with lower respiratory tract infection.Results A total of 260 strains of pathogenic bacteria were detected.57.31%were 149 strains of Gram negative bacteria,mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii.30.38%were Gram positive bacteria,mainly Streptococcus pneumoniae and Staphylococcus aureus.12.31%were fungi,mainly Candida albicans.Comparing the distribution characteristics of pathogenic bacteria in patients of different age groups,the proportion of Gram negative bacteria in the elderly group was 63.89%,the proportion of Gram negative bacteria in the non elderly group was 49.14%,the proportion of Gram positive bacteria in the elderly group was 22.22%,and the proportion of Gram negative bacteria in the non elderly group was 40.52%.The difference was statistically significant(P<0.05).The fungal composition of elderly patients was 13.89%,while the fungal composition of non elderly patients was 10.34%,with no statistically significant difference(P>0.05).The proportion of Gram negative bacteria in the long course group was 67.35%,the proportion of Gram negative bacteria in the short course group was 51.23%,the proportion of Gram positive bacteria in the long course group was 20.41%,and the proportion of Gram positive bacteria in the short course group was 36.42%.The difference in comparison was statistically significant(P<0.05).The fungal composition of patients in the long course group was 12.24%,while the fungal composition of patients in the short course group was 12.35%,with no statistically significant difference(P>0.05).After 7 days of treatment,the recovery rate of the observation group patients was 52.31%,and the total effective rate was 89.23%.The recovery rate of the control group patients was 44.62%,and a total effective rate of 74.62%.The difference in total effective rate between the two groups of patients was statistically significant(P<0.05).The bacterial clearance rate in the observation group was 90.77%,while the bacterial clearance rate in the control group was 80.77%,with a statistically significant difference(P<0.05).The serum SAA level at admission was(85.09±17.58)mg/L in the patients with combined lower respiratory tract infection,(52.72±11.13)mg/L in the non infected group,and(11.97±0.29)mg/L in the healthy control group.The difference was statistically significant(P<0.05).The CPIS score of patients with chronic obstructive pulmonary disease and lower respiratory tract infection was(8.01±0.72)on admission,and(8.36±0.68)on the third day of admission.The CPIS score was positively correlated with serum SAA level,at admission and on the third day of admission.Conclusion The main pathogenic bacteria in patients with chronic obstructive pulmonary disease and lower respiratory tract infection were Gram negative bacteria.There was a statistically significant difference in the composition of Gram negative and Gram positive bacteria among patients of different ages and disease course groups.The clinical efficacy and bacterial clearance effect of cefoperazone/sulbactam combined with moxifloxacin in the treatment of chronic obstructive pulmonary disease with lower respiratory tract infection were good.The severity of infection was strongly correlated with serum SAA levels.