目的 探討慢性阻塞性肺疾病急性加重期(AECOPD)患者的病原學特點及其與肺功能的關系。方法 對64例AECOPD患者行肺功能測定,痰細菌定量、定性培養(yǎng)和藥物敏感試驗以及血清支原體、衣原體抗體檢測。根據肺功能第一秒用力呼氣容積占預計值百分比(FEV1%pred)將患者分為三組:Ⅰ組(50%≤FEV1 lt;80%pred)、Ⅱ組(30%≤FEV1 lt;50%pred)和Ⅲ組(FEV1 lt;30%pred);同時根據痰培養(yǎng)結果將感染細菌分為A(G+菌),B(除C類以外的G-菌),C(不動桿菌、腸桿菌及假單胞菌),D痰菌陰性四類。比較三組患者肺功能損害程度與感染細菌種類之間的關系。結果 ⑴64例行痰定量培養(yǎng)患者感染細菌以肺炎鏈球菌、腸桿菌、卡他莫拉菌及假單胞菌為主。其中38例同時行痰定性培養(yǎng)的住院患者以肺炎鏈球菌、表皮葡萄球菌、不動桿菌和腸桿菌為多,且多為混合感染。⑵痰定量與定性培養(yǎng)均為Ⅰ組患者以痰菌陰性為主,Ⅲ組患者以耐藥A類菌及C類菌為主,P分別 lt;0.01和0.05。⑶29.4%的AECOPD患者有支原體或衣原體感染。結論 AECOPD患者感染細菌種類與肺功能損害的嚴重程度密切相關,肺功能損害越嚴重,耐藥肺炎鏈球菌等G+球菌、不動桿菌、腸桿菌及假單胞菌分離率越高。
引用本文: 許建英,李筱妍,杜永成,楊麗莉,王淑峰,王紅. 慢性阻塞性肺疾病急性加重期病原學與肺功能關系的研究. 中國呼吸與危重監(jiān)護雜志, 2007, 6(2): 88-93. doi: 復制
1. | 趙鳴武.重視對慢性阻塞性肺疾病急性加重的病因學及其對策的研究.中國呼吸與危重監(jiān)護雜志,2004,3:67. |
2. | Eller J,Ede A,Schaberg T,et al.Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function.Chest,1998,113:1542-1548. |
3. | Monso E,Ruiz J,Rosell A,et al.Bacterial infection in chronic obstructive pulmonary disease.Am J Respir Crit Care Med,1995,152:1316-1320. |
4. | 中華醫(yī)學會呼吸病學分會慢性阻塞性肺疾病學組.慢性阻塞性肺疾病診治指南.中華內科雜志,2002,41:640-646. |
5. | 熊彬,王榮麗,曹乃清,等.慢性阻塞性肺疾病急性加重期痰細菌培養(yǎng)與肺功能關系探討.實用心腦肺血管病雜志,2004,12:83-85. |
6. | Miravitlles M,Espinosa C,F(xiàn)ernandez-Laso E,et al.Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD.Study Group of Bacterial Infection in COPD.Chest,1999,116:40-46. |
7. | 馬春玲,張紀云,夏麗華.口痰細菌定量培養(yǎng)方法及其應用.臨沂醫(yī)專學報,1995,17:293-294. |
8. | 陳慧生,李慶棣,梁冰.簡化痰細菌定量培養(yǎng)法的臨床應用和評價.臨床薈萃,1994,9:570-572. |
9. | 霍建民,楊光,張俊梅,等.COPD患者急性加重期細菌學與肺功能關系的初步研究.中國急救醫(yī)學,2002,22:35. |
10. | 林英翔,王辰,杜小玲,等.慢性阻塞性肺病急性加重期痰細菌學培養(yǎng)與肺功能的關系.中華醫(yī)院感染學雜志,2002,12:182-183. |
11. | 劉又寧,陳民鈞,趙鐵梅,等.中國城市成人社區(qū)獲得性肺炎665例病原學多中心調查.中華結核和呼吸雜志,2006,29:3-8. |
12. | 楊文杰,陶家駒,衛(wèi)京平,等.慢性阻塞性肺疾病急性發(fā)作病原學及臨床特點分析.中華臨床醫(yī)藥,2003,4:49-51. |
13. | 何禮賢,李錫瑩.下呼吸道感染的細菌學診斷方法評價.中華結核和呼吸雜志,1987,10:183-186. |
14. | Kilbourn JP,Campbell RA,Grach JL,et al.Quantitative bacteriology of sputum.Am Rev Respir Dis,1968,98:810-818. |
15. | Hill AT,Campbell EJ,Hill SL,et al.Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis.Am J Med,2000,109:288-295. |
16. | Sethi S,Muscarella K,Evans N,et al.Airway inflammation and etiology of acute exacerbations of chronic bronchitis.Chest,2000,118:1557-1565. |
17. | Miravitlles M.Exacerbations of chronic obstructive pulmonary disease:when are bacteria important? Eur Respir J,2002,36:9s-19s. |
- 1. 趙鳴武.重視對慢性阻塞性肺疾病急性加重的病因學及其對策的研究.中國呼吸與危重監(jiān)護雜志,2004,3:67.
- 2. Eller J,Ede A,Schaberg T,et al.Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function.Chest,1998,113:1542-1548.
- 3. Monso E,Ruiz J,Rosell A,et al.Bacterial infection in chronic obstructive pulmonary disease.Am J Respir Crit Care Med,1995,152:1316-1320.
- 4. 中華醫(yī)學會呼吸病學分會慢性阻塞性肺疾病學組.慢性阻塞性肺疾病診治指南.中華內科雜志,2002,41:640-646.
- 5. 熊彬,王榮麗,曹乃清,等.慢性阻塞性肺疾病急性加重期痰細菌培養(yǎng)與肺功能關系探討.實用心腦肺血管病雜志,2004,12:83-85.
- 6. Miravitlles M,Espinosa C,F(xiàn)ernandez-Laso E,et al.Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD.Study Group of Bacterial Infection in COPD.Chest,1999,116:40-46.
- 7. 馬春玲,張紀云,夏麗華.口痰細菌定量培養(yǎng)方法及其應用.臨沂醫(yī)專學報,1995,17:293-294.
- 8. 陳慧生,李慶棣,梁冰.簡化痰細菌定量培養(yǎng)法的臨床應用和評價.臨床薈萃,1994,9:570-572.
- 9. 霍建民,楊光,張俊梅,等.COPD患者急性加重期細菌學與肺功能關系的初步研究.中國急救醫(yī)學,2002,22:35.
- 10. 林英翔,王辰,杜小玲,等.慢性阻塞性肺病急性加重期痰細菌學培養(yǎng)與肺功能的關系.中華醫(yī)院感染學雜志,2002,12:182-183.
- 11. 劉又寧,陳民鈞,趙鐵梅,等.中國城市成人社區(qū)獲得性肺炎665例病原學多中心調查.中華結核和呼吸雜志,2006,29:3-8.
- 12. 楊文杰,陶家駒,衛(wèi)京平,等.慢性阻塞性肺疾病急性發(fā)作病原學及臨床特點分析.中華臨床醫(yī)藥,2003,4:49-51.
- 13. 何禮賢,李錫瑩.下呼吸道感染的細菌學診斷方法評價.中華結核和呼吸雜志,1987,10:183-186.
- 14. Kilbourn JP,Campbell RA,Grach JL,et al.Quantitative bacteriology of sputum.Am Rev Respir Dis,1968,98:810-818.
- 15. Hill AT,Campbell EJ,Hill SL,et al.Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis.Am J Med,2000,109:288-295.
- 16. Sethi S,Muscarella K,Evans N,et al.Airway inflammation and etiology of acute exacerbations of chronic bronchitis.Chest,2000,118:1557-1565.
- 17. Miravitlles M.Exacerbations of chronic obstructive pulmonary disease:when are bacteria important? Eur Respir J,2002,36:9s-19s.