• 1上海長(zhǎng)征醫(yī)院臨床醫(yī)學(xué)院(上海200003);;
  • 2復(fù)旦大學(xué)附屬中山醫(yī)院呼吸內(nèi)科;;
  • 3江蘇省昆山市中醫(yī)院內(nèi)二科;

目的  探討COPD急性加重期(AECOPD)細(xì)菌感染的作用，比較不同分離菌對(duì)氣道炎癥的影響。方法  收集按GOLD 2004標(biāo)準(zhǔn)診斷的AECOPD患者的痰標(biāo)本159例，進(jìn)行常規(guī)培養(yǎng)及細(xì)菌鑒定?？┠撔蕴档腁ECOPD患者按痰中主要分離菌進(jìn)行分組，比較不同分離菌組與未分離到細(xì)菌組(NG)，以及正常對(duì)照組(NC)痰標(biāo)本中IL-6、IL-8和TNF-α的水平。結(jié)果  129例痰標(biāo)本細(xì)菌培養(yǎng)陽(yáng)性，分別為副流感嗜血桿菌(HP)37例(不包括混合感染，28.7％)，肺炎克雷伯菌(KB) 26例(20.2％)、流感嗜血桿菌(Hi)21例(16.3％)、銅綠假單胞菌(PA)17例(13.2％)，不動(dòng)桿菌5 例(3.9％)，嗜麥芽窄食單胞菌、肺炎鏈球菌、液化沙雷菌、糞鏈球菌各4例(3.1％)，其他菌7例 (5.4％)。其中混合感染20例，均為合并副流感嗜血桿菌。膿性痰97例，按痰中的主要分離菌分為5組：HP組24例，Hi組20例，PA組l6例，KB組19例，NG組l8例。與NC組比較，PA、Hi和 KB組痰中IL一8、TNF-α的濃度顯著增高(P均 lt;0.05)，PA組、Hi組高于KB組(P lt;0.05)。各分離組痰上清液中IL-6的濃度均顯著高于NC組(P均 lt;0.05)，但各分離組間無(wú)明顯差異(P均 gt; 0.05)。結(jié)論  細(xì)菌感染在AECOPD中起重要作用，AECOPD患者痰中出現(xiàn)細(xì)菌感染引起的炎癥因子水平升高，尤以PA、Hi及KB引起的炎癥為重。

引用本文： 蔣鑫,王桂芳,錢(qián)建美,白春學(xué). 慢性阻塞性肺疾病急性加重期病原學(xué)與氣道炎癥關(guān)系的研究. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 08(6): 416-420. doi: 復(fù)制

1. Parker CM ，Voduc N，Aaron SD，et al.Physiological changes during symptom recovery from moderate exacerbations of COPD．Eur Respir J，2005，26：420428.
2. Nseir S，Di Pompeo C，Cavestri B，et al．Multiple—diaig-resistant bac— teria in patients with severe acute exacerbation of chronic obstructive pulmonary disease：Prevalence，risk factors，and outcome．Crit Care Med．2006．34：2959-2966.
3. Diederen BM ，van der Valk PD，Kluytmans JA，et a1．The role of a— typical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease．Eur Respir J，2007，30：240·244.
4. Cameron RJ，de Wit D，Welsh TN，et a1．Virus infection in exacerbations of chronic obstructive pulmonary disease requiring ventila— tion．Intensive Care Med，2006，32：1022-1029.
5. Global Initiative for Chronic Obstructive Lung Disease(GOLD) Global strategy for the diagnosis，management，and prevention of chronic obstructive pulmonary disease：updated 2004．NHLBI／WHO workshop report．Bethesda，MD：US Department of Health and Human Services，2004，National Institutes of Health publication No．2701.
6. Bach PB，Brown C，Gelfand SE，et al．Management of acute exacerbations of chronic obstructive pulmonary disease：a summary and appraisal of published evidence．Ann Intern Med，2001，134：600-620.
7. Bhowmik A，Seemungal TAR，Sapsford RJ，et a1．Comparision of spontaneous and induced sputum for investigation of airway inflam— marion in chronic obstructive pulmonary disease．Thorax，1998，53： 953-956.
8. 修清玉，方正，賴國(guó)祥，等．改良流感嗜血桿菌培養(yǎng)基的實(shí)驗(yàn)研究與評(píng)價(jià)．中華醫(yī)學(xué)檢驗(yàn)雜志，1998，21：161-163. 9 Kolls WE，Bannerman TL Staphylococcus and Micrococcus．In： Mrrry PR，Baron EJ，Pfalier MA，et a1．Mannual of clinical microbiology， 7th ed．Washington DC．American Society of Microbiology ， 1999，264-282.
9. Khair OA。Davies RJ，Devalia JL Bacterial induced release of in. flammatory mediators by bronchial epithelial cells．Eur Respir J， 1996，9：1913-1922.
10. 曾勉，關(guān)開(kāi)泮，黃曉梅，等．慢性阻塞性肺疾病患者誘導(dǎo)痰促炎／抗炎介質(zhì)水平的變化．中國(guó)呼吸與危重監(jiān)護(hù)雜志，2007，6：373.
11. Sethi S，Musearella K，Evans N，et at．Airway inflammation and aetiology of acute exacerbations of chronic bronchitis．Chest，2000，1 1 8： 1557．1565.
12. Hill AT，Campbell EJ，Hill SL，et a1．Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis．Am J Med，2000，109：288-295.
13. Seemungal TA，Harper-Owen R，Bhowmik A，et a1．Detection of rhinovirus in induced sputum at exacerbation of chronic obstructive pulmonary disease．Eur Respir J，2000，16：677-683．.
14. .
  1. 1. Parker CM ，Voduc N，Aaron SD，et al.Physiological changes during symptom recovery from moderate exacerbations of COPD．Eur Respir J，2005，26：420428.
  2. 2. Nseir S，Di Pompeo C，Cavestri B，et al．Multiple—diaig-resistant bac— teria in patients with severe acute exacerbation of chronic obstructive pulmonary disease：Prevalence，risk factors，and outcome．Crit Care Med．2006．34：2959-2966.
  3. 3. Diederen BM ，van der Valk PD，Kluytmans JA，et a1．The role of a— typical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease．Eur Respir J，2007，30：240·244.
  4. 4. Cameron RJ，de Wit D，Welsh TN，et a1．Virus infection in exacerbations of chronic obstructive pulmonary disease requiring ventila— tion．Intensive Care Med，2006，32：1022-1029.
  5. 5. Global Initiative for Chronic Obstructive Lung Disease(GOLD) Global strategy for the diagnosis，management，and prevention of chronic obstructive pulmonary disease：updated 2004．NHLBI／WHO workshop report．Bethesda，MD：US Department of Health and Human Services，2004，National Institutes of Health publication No．2701.
  6. 6. Bach PB，Brown C，Gelfand SE，et al．Management of acute exacerbations of chronic obstructive pulmonary disease：a summary and appraisal of published evidence．Ann Intern Med，2001，134：600-620.
  7. 7. Bhowmik A，Seemungal TAR，Sapsford RJ，et a1．Comparision of spontaneous and induced sputum for investigation of airway inflam— marion in chronic obstructive pulmonary disease．Thorax，1998，53： 953-956.
  8. 8. 修清玉，方正，賴國(guó)祥，等．改良流感嗜血桿菌培養(yǎng)基的實(shí)驗(yàn)研究與評(píng)價(jià)．中華醫(yī)學(xué)檢驗(yàn)雜志，1998，21：161-163. 9 Kolls WE，Bannerman TL Staphylococcus and Micrococcus．In： Mrrry PR，Baron EJ，Pfalier MA，et a1．Mannual of clinical microbiology， 7th ed．Washington DC．American Society of Microbiology ， 1999，264-282.
  9. 9. Khair OA。Davies RJ，Devalia JL Bacterial induced release of in. flammatory mediators by bronchial epithelial cells．Eur Respir J， 1996，9：1913-1922.
  10. 10. 曾勉，關(guān)開(kāi)泮，黃曉梅，等．慢性阻塞性肺疾病患者誘導(dǎo)痰促炎／抗炎介質(zhì)水平的變化．中國(guó)呼吸與危重監(jiān)護(hù)雜志，2007，6：373.
  11. 11. Sethi S，Musearella K，Evans N，et at．Airway inflammation and aetiology of acute exacerbations of chronic bronchitis．Chest，2000，1 1 8： 1557．1565.
  12. 12. Hill AT，Campbell EJ，Hill SL，et a1．Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis．Am J Med，2000，109：288-295.
  13. 13. Seemungal TA，Harper-Owen R，Bhowmik A，et a1．Detection of rhinovirus in induced sputum at exacerbation of chronic obstructive pulmonary disease．Eur Respir J，2000，16：677-683．.
  14. 14. .