冬季慢性阻塞性肺疾病急性加重住院患者病原学与预后分析  

Investigation of etiology and prognosis of the hospitalized patients with chronic obstructive pulmonary disease during acute exacerbation

作　　者：阎锡新[1] 徐海博[1] 田茶[2] 齐顺祥[2] 韩彩芝[2] 李素引[3] 赵瑞珍[4] 杨丛丽[5] 刘菲菲 王瑜玲[7] 韩晓文[8] 平芬[9] 蒋超英[10] 金普乐[11] 

机构地区：[1]河北医科大学第二医院呼吸内科河北省呼吸病研究所,石家庄050000 [2]河北省疾病预防控制中心,石家庄050000 [3]衡水市哈励逊国际和平医院,河北衡水053000 [4]河北医科大学第三医院呼吸科,石家庄050000 [5]石家庄市第二医院呼吸内科,石家庄050000 [6]秦皇岛市人民医院呼吸内科,河北秦皇岛066000 [7]石家庄市第一医院呼吸内科,石家庄050000 [8]河北省人民医院呼吸内科,石家庄050000 [9]河北省人民医院老年病四科,石家庄050000 [10]白求恩国际和平医院呼吸内科,石家庄050000 [11]河北医科大学第四医院呼吸内科,石家庄050000

出　　处：《中国实用内科杂志》2010年第4期320-323,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的了解慢性阻塞性肺疾病急性加重(AECOPD)患者下呼吸道病原学分布,探讨不同病原体感染对AECOPD患者康复及气道炎症反应的影响。方法收集2008-11-15—2009-03-15河北省10家医院呼吸内科住院3d内的AECOPD患者的痰液,记录相关临床资料。以细菌聚合酶链式反应(PCR)试剂盒和病毒PCR试剂盒对106份合格痰标本进行检测。酶联免疫吸附法(ELISA)测定88份痰液中白介素6(IL-6)和肿瘤坏死因子α(TNF-α)含量。结果病毒阳性率为37.7%,最常见的是甲型流感病毒(16.0%)、鼻病毒(10.4%)。细菌的阳性率为40.6%,最常见的是肺炎链球菌(26.4%)。病毒阳性组平均康复时间31.59d,阴性组14.82d,两组比较差异有统计学意义(P=0.02)。病毒阳性组痰中IL-6含量(114.92±44.82)ng/L高于阴性组(70.74±46.59)ng/L(P<0.001);两组TNF-α含量差异无统计学意义。细菌阳性组与阴性组痰中IL-6、TNF-α含量差异均无统计学意义。多种病毒感染者痰中IL-6含量(122.51±39.86)ng/L高于单一病毒感染(65.30±34.92)ng/L(P=0.005);细菌与病毒混合感染者痰中IL-6含量(120.31±46.62)ng/L高于单一感染(83.61±47.83)ng/L(P=0.02)。结论肺炎链球菌、甲型病毒是AECOPD早期的重要诱因;而病毒感染患者康复时间明显延长;同时痰中IL-6含量显著升高,提示病毒是加重COPD气道炎症反应的重要诱因;甲型流感病毒应受到关注。Objective To understand the etiology of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and study the effect of different infections on the recovery and inflammatory factors of hospitalized patients with AECOPD. Methods The sputum samples were collected from 106 hospi- talized patients with AECOPD within 3 d of admission and the related clinical data of patients were recorded. Bacteria polymerase chain reaction（PCR） kits and virus PCR kits were used to detect etiology of 106 qualified sputum samples respectively. The concentration of interleukin-6 （IL-6）and tumor necrosis factor alpha（TNF-ot） in 88 sputum samples were measured by Enzyme-linked Immtmosorbent Assay（ELISA）. Results The positive rate of virus was 37. 7%, and influenza virus A （ 16.0% ） and rhinovirus （ 10. 4% ） was the most frequent virus. The positive rate of bacteria was 40. 6% ,and Streptococcus pneumonia（26. 4% ）was the most frequent one. The average recovery time in viruspositive group（31.59 d）was higher than in virusnegative group（ 14. 82 d） ,and the recovery rates of two groups were significantly different （P = 0.02 ）. The concentration of IL-6 （ 114. 92 ±44. 82 ）ng/L in sputum samples of virus-positive group was higher than in virus-negative group（ 70. 74 ±46. 59 ）ng/L, but TNF-otwas not signifieanrly,different between two groups. The concentration of IL-6 and TNF-α in sputum was not significantly different between bacteria-positive and bacteria-negative groups （ P 〉 0. 05 ）. The concentration of IL-6 in sputum of multi-virus infection group （ 122. 51 ±39. 86 ） ng/L was higher than in single virus infection group （ 65. 30 ±34. 92 ）ng/L： The concentration of IL-6 in sputum of bacteria-virus mixed infection group（ 120. 31 ± 46. 62 ）ng/L was higher than in bacteria or virus single infection group （ 83.61 ± 47. 83 ） ng/L. Conclusion Streptococcus pneumonia and influenza virus A infection are important factors in AECOP

关 键 词：慢性阻塞性肺疾病 病毒 细菌 聚合酶链式反应 

分 类 号：R5[医药卫生—内科学]