摘要
目的探讨COPD急性加重期(AECOPD)细菌感染的作用,比较不同分离菌对气道炎症的影响。方法收集按GOLD 2004标准诊断的AECOPD患者的痰标本159例,进行常规培养及细菌鉴定。咯脓性痰的AECOPD患者按痰中主要分离菌进行分组,比较不同分离菌组与未分离到细菌组(NG),以及正常对照组(NC)痰标本中IL-6、IL-8和TNF-α的水平。结果129例痰标本细菌培养阳性,分别为副流感嗜血杆菌(HP)37例(不包括混合感染,28.7%),肺炎克雷伯菌(KB)26例(20.2%)、流感嗜血杆菌(Hi)21例(16.3%)、铜绿假单胞菌(PA)17例(13.2%),不动杆菌5例(3.9%),嗜麦芽窄食单胞菌、肺炎链球菌、液化沙雷菌、粪链球菌各4例(3.1%),其他菌7例(5.4%)。其中混合感染20例,均为合并副流感嗜血杆菌。脓性痰97例,按痰中的主要分离菌分为5组:HP组24例,Hi组20例,PA组16例,KB组19例,NG组18例。与NC组比较,PA、Hi和KB组痰中IL-8、TNF-α的浓度显著增高(P均<0.05),PA组、Hi组高于KB组(P<0.05)。各分离组痰上清液中IL-6的浓度均显著高于NC组(P均<0.05),但各分离组间无明显差异(P均>0.05)。结论细菌感染在AECOPD中起重要作用,AECOPD患者痰中出现细菌感染引起的炎症因子水平升高,尤以PA、Hi及KB引起的炎症为重。
Objective To study the effect of bacterial infection on acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, and to compare the airway inflammation caused by different isolated bacteria. Methods A total of 159 sputum samples were collected from AECOPD patients diagnosed according to GOLD 2004 standard, in which conventional culture and identification of bacteria was conducted. The patients with purulent sputa were divided into different groups according to bacteria separated. Levels of IL-6, IL-8 and TNF-α in sputum supernatant were assayed and compared in different bacteria groups,the purulent sputum without isolated bacteria group （NG） and normal control group（NC）. Results One hundred and twenty-nine strains of bacteria were isolated in 159 qualified sputa, including 26 strains of Klebsiella pneumoniae （ KB ）, 21 strains of Hemophilus influenza （ Hi ） , 17 strains of Pseudomonas aeruginosa （ PA ）, 37 strains of Haemophilus parainfluenzae （ HP ） （ mixed infection not included） and 28 strains of other bacteria. Among of all samples,20 were double infection of Haemophilus parainfluenzae with another bacterium. Ninety-seven purulent sputa were collected. According to bacteria isolated, these sputa were divided into five groups, named HP （ 24 samples ）, Hi （20 samples）, PA （ 16 samples） ,KB（ 19 samples） and NG（ 18 samples）. Contrast to NC, concentration of IL-8 and TNF-α rose in sputa from which PA, Hi, KB were isolated （ P 〈 0.05 ）. The level increased much more in sputa from which PA and Hi were isolated compared with KB（P 〈 0. 05）. Concentration of IL-6 rose in sputa of each group collected from AECOPD patients contrast to sputa collected from NC （ P 〈 0. 05 ）, without significant differences among all other group except for NC. Conclusions Bacterial infection plays an important role in AECOPD characterized with high level of inflammatory factors especially when PA, Hi, KB were infected bacteria. This study provides evidence for antibacterial therapy in AECOPD patients.
出处
《中国呼吸与危重监护杂志》
CAS
2008年第6期416-420,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
上海市重点学科建设项目(编号:B115)
上海市"慢性阻塞性肺病诊治技术研究"(编号:074119507)
关键词
慢性阻塞性肺疾病
急性加重
细菌感染
气道炎症
Chronic obstructive pulmonary disease
Acute exacerbation
Bacterial infection
Airway inflammation
