CTD-ILD合并肺部感染患者肺部微生物菌群特点及对肺纤维化的影响

Characteristics of Pulmonary Microbiota in Patients with CTD-ILD Combined with Pulmonary Infection and Their Impact on Pulmonary Fibrosis

目的探讨结缔组织病相关间质性肺疾病(CTD-ILD)合并肺部感染患者肺部微生物菌群特点及对肺纤维化的影响。方法选取2021年2月至2022年5月在医院治疗的45例CTD-ILD合并肺部感染患者作为观察组,同时选取45例CTD-ILD未合并肺部感染患者作为对照组,比较两组肺功能、高分辨CT(HRCT)肺纤维化评分,同时分析观察组病原菌分布情况。结果观察组用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气容积占预计值百分比(FEV 1%pred)、一氧化碳弥散量占预计值百分比(DLCO%pred)、用力肺活量(FVC)、最大呼气流量(MEF)和残气容积(RV)低于对照组(P<0.05);观察组HRCT影像学斑片状、支气管扩张比率高于对照组(P<0.05),CT纤维化评分高于对照组(P<0.05)。观察组病原菌分布:细菌分布中以肺炎克雷伯菌、铜绿假单胞菌为主,分别占24.44%和15.56%,病毒检出巨细胞病毒、人类疱疹病毒,分别占11.11%和6.67%,真菌检出白念珠菌,占11.11%。观察组年龄≥60岁患者CT纤维化评分高于年龄<60岁患者(P<0.05)。结论CTD-ILD合并肺部感染患者以细菌感染为主;相比较未合并肺部感染患者,合并肺部感染患者肺纤维化较重。

Objective To investigate the characteristics of pulmonary microbiota in patients with connective tissue disease associated interstitial lung disease(CTD-ILD)combined with pulmonary infection and their impact on pulmonary fibrosis.Methods A total of 45 patients with CTD-ILD complicated with pulmonary infection treated in the hospital from February 2021 to May 2022 were selected as the observation group,while 45 patients with CTD-ILD without pulmonary infection were selected as the control group,the differences in lung function and high resolution CT(HRCT)pulmonary fibrosis score between the two groups were compared,and the distribution of pathogens in the observation group was analyzed.Results In the observation group,the percentage of forced vital capacity to the predicted value(FVC%pred),the percentage of forced expiratory volume in the first second to the predicted value(FEV 1%pred),the percentage of carbon monoxide diffusion volume to the predicted value(DLCO%pred),forced vital capacity(FVC),maximum expiratory flow(MEF)and residual volume(RV)were lower than those of the control group(P<0.05).The observation group had higher rates of patchy HRCT imaging and bronchiectasis compared to the control group(P<0.05),while the CT fibrosis score was higher than that of the control group(P<0.05).In the distribution of pathogenic bacteria in the observation group,Klebsiella pneumoniae and Pseudomonas aeruginosa were the main bacteria,accounting for 24.44%and 15.56%,respectively.Cytomegalovirus and human herpesvirus were detected in the virus,accounting for 11.11%and 6.67%,respectively.Candida albicans was detected in the fungus,accounting for 11.11%.The CT fibrosis score of patients aged≥60 years in the observation group was higher than that of patients aged<60 years(P<0.05).Conclusion Patients with CTD-ILD combined with pulmonary infection are mainly infected with bacteria.Compare with patients without pulmonary infection,patients with pulmonary infection has more severe pulmonary fibrosis.