摘要
目的研究慢性阻塞性肺疾病（ＣＯＰＤ）细菌学特征、细菌感染与小气道病变的关系。方法对门诊ＣＯＰＤ急性加重期（３０例）与稳定期患者（２５例）、慢性支气管炎急性加重期（１６例）与稳定期患者（２５例）行纤维支气管镜与超细纤维支气管镜检查，以保护性标本刷在大、小气道（２ｍｍ直径）取样作细菌定量培养。结果ＣＯＰＤ急性加重期致病菌阳性率２６６％（８／３０），慢性支气管炎（ＣＢ）急性加重期致病菌阳性率２３５％（５／１７）。ＣＯＰＤ急性加重期主要致病菌为金黄色葡萄球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌和铜绿假单胞菌。细菌均存在于大气道，２株在小气道同时存在。ＣＯＰＤ稳定期致病菌阳性率为２４０％（６／２５），ＣＢ稳定期致病菌阳性率１１７％（２／１７）。ＣＯＰＤ稳定期主要致病菌为表皮葡萄球菌、微球菌及肺炎链球菌等，细菌量＜１０×１０３ｃｆｕ／ｍｌ，主要在大气道。ＣＯＰＤ急性加重期与稳定期细菌感染组与未感染组小气道病变程度差异无显著性（Ｐ＞０．０５）。结论稳定期ＣＯＰＤ细菌感染不是主要致病问题；ＣＯＰＤ小气道病变程度与细菌感染没有直接因果关系。
Objective To investigate the association of bacteriologic characteristics and bacterial infection in small airway disease. Methods Fiberoptic bronchoscopy and ultrathin fiberoptic bronchoscopy were performed on outpatients with COPD and chronic bronchitis both during stable stage and acute exacerbation. Samples were obtained from both large and small airways by protective specimen brush, and bacteria were cultured quantitatively. Results The positive rates for pathogens in patients with COPD and chronic bronchitis during acute exacerbation were 26.6%(8/30) and 23.5%(5/17) respectively. Major pathogens in acute COPD include Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, and Pseudomonas aeruginosa. All of the pathogens were present in large airways, with 2 strains present in small airways concurrently. The positive rates for pathogens in stable COPD and chronic bronchitis were 24.0%(6/24) and 11.7%(2/17) respectively. Major pathogens found in stable COPD include Staphylococcus epidermis, Micrococcus and Streptococcus pneumoniae. The bacteria were less than 10×10 3 cfu/ml, present mainly in large airways. There was no significant difference in the extent of small airway diseases between COPD with bacterial infection and that without bacterial infection ( P >0.05). Conclusions Bacterial infection is not a major pathogenic factor in stable COPD. There is no direct cause and effect relationship between bacterial infection and the extent of small airway diseases in patients with COPD.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
1999年第2期88-91,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
