中重度慢性阻塞性肺疾病患者稳定期BODE积分与再次急性加重时致病菌关系的研究  

The relationship between the BODE score in stable moderate to severe chronic obstructive pulmonary disease and the pathogenic bacteria detected in secondly acute exacerbation

作　　者：何顺平 刘志锋 黄江 李冬梅 

机构地区：[1]韶关市第一人民医院呼吸内科,512000

出　　处：《国际呼吸杂志》2013年第15期1140-1143,共4页International Journal of Respiration

摘　　要：目的探讨中重度慢性阻塞性肺疾病（COPD）患者稳定期BODE积分与再次急性加重时致病菌关系。方法97例纳入研究的患者中，中度42例，重度55例，在进入稳定期后进行BODE指数评分，并在再次出现急性加重初期（行抗生素治疗前）分别取痰标本和血液标本进行细菌学检查，分析不同BODE积分段患者的细菌学检查结果。结果根据BODE积分分组，A组（O～3分）32例，B组（4～6分）29例，C组（7～10分）36例。97例患者痰或血培养中共鉴定出致病菌46株，其中革兰阴性菌25株（54．35％），革兰阳性菌15株（32．61％），真菌6株（13．04％）。C组痰细菌培养阳性率（61．1％，22／36）和血细菌培养阳性率（25．0％，9／36）均较A组（31．3％，10／32；6．3％，2／32）显著升高（Х^2=6．0635，P=0．0138；Х^2=4．3923，P=0．0361），C组致病菌中革兰阴性菌阳性率（36．1％，13／36）也较A组（9．4％，3／32）显著升高（Х^2=4．7407，P=0．0295），多重耐药菌株主要出现在C组病例标本中，与A组相比，差异有统计学意义（Х^2=9．2203，P：0．0024）。而比较以单纯肺功能分级为基础的中、重度两组患者的细菌感染种类及多重耐药菌发生率，差异均无统计学意义。结论在COPD稳定期测得BODE积分较高的患者再次出现急性加重时，革兰阴性菌感染发生率较高，且可能出现较复杂的感染情况。Objective To investigate the scores of BODE index in stable moderate to severe chronic obstructive pulmonary disease（COPD） and their relationship to the distribution and resistance of the pathogens detected in secondly acute exacerbations of COPD. Methods Ninty-seven patients （42 with moderate and 55 with severe COPD） were evaluated for BODE scores in stable phase of COPD,including the routine pulmonary function test, the body mass index, MRC dyspnoea sore, 6-minute walt test, the eligible sputum specimen and blood sample were cultured for bacteria and fungi in newly acute exacerbation. All data were statistically analyzed with SPSS 11.5 for windows. Results According to the the BODE scores,32 cases with BODE index score 0-3 were divided into A group, 29 cases with score 4- 6 were B group, 36 cases with score 7-10 were C group. 97 cases of sputum culture and blood cultures in patients, a total of 46 strains identified pathogens, including 25 strains of Gram negative bacteria （54.35%）, 15 strains of Gram positive bacteria （32.61%）, 6 strains of fungi （13.04%）. Patients in C group has higher positive rate of sputum culture and hemoculture than A group （61.1%0,22/36;25.0%, 9/36 vs 31.3%, 10/32; 6.3%, 2/32）, （ Х^2= 6. 063 5, P = 0. 013 8;Х^2= 4. 392 3, P = 0. 036 1 ）. Detection rate of Gram-negative Bacteria in sputum sample from C group was significantly higher than A group （36.1% ,13/36 vs 9.4% ,3/32;Х^2=4. 740 7, P =0. 029 5）. Multi-resistant strains were seen in the cases of group C specimens, compared with group A, the difference was statistically significant （Х^2= 9. 220 3, P =0. 002 4）. Compare the two groups of patients in severe bacterial infections based on simple lung function classification types and multi-resistant incidence, the difference did not reach statistical significance. Conclusions Patients in the stable phase of COPD measured by BODE integral higher again in acute exacerbation, a higher incidence of Gram-negative bacteria infection, and infection may occ

关 键 词：肺疾病 慢性阻塞性 病原菌 BODE积分 

分 类 号：R563.9[医药卫生—呼吸系统]