稳定期老年COPD患者下呼吸道细菌定植与肺功能的相关性  

Correlation between lower airway bacterial colonization and lung function in elderly patients with stable chronic obstructive pulmonary disease

作　　者：孟鸿琼 龙琼华[1] 苏慧鹏 金醒昉[1] 邓洁[1] 胡阳[1] MENG Hong-qiong;LONG Qiong-hua;SU Hui-peng;JIN Xing-fang;DENG Jie;HU Yang(Department of Geriatrics,Yan＇an Affiliated Hospital of Kunming Medical University,Kunming 650031,Yunnan,CHINA)

机构地区：[1]昆明医科大学附属延安医院老年病科,云南昆明650031

出　　处：《海南医学》2018年第20期2836-2839,共4页Hainan Medical Journal

基　　金：云南省教育厅科学研究基金项目(编号:2014Y164);云南省昆明市卫生和计划生育委员会医药卫生科技计划项目(编号:2018-03-02-009)

摘　　要：目的研究稳定期老年慢性阻塞性肺疾病(COPD)患者不同程度肺功能下呼吸道细菌定植(LABC)情况,并探讨其相关性。方法纳入2014年1月至2015年12月昆明医科大学附属延安医院老年病科慢病管理人群中诊断明确的老年(≥65岁)稳定期COPD患者86例,对其诱导痰液或支气管肺泡灌洗液(BALF)进行细菌学定量,根据患者LABC情况分为LABC阳性者与LABC阴性者,应用酶联免疫吸附法(ELISA)检测患者血清白介素6 (IL-6)、白介素8 (IL-8)、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子-α(TNF-α)水平,同时测定肺活量(FVC)、第一秒用力呼气容积(FEV1)、FEV1%预计值(FEV1%pred)、FEV1/FVC。比较两组患者的肺功能及炎性因子水平。结果 86例COPD患者中有39例存在下呼吸道细菌定植,细菌定植率为45.35%;LABC阳性组患者的FEV1%pred、FEV1/FVC水平及急性发作次数分别为(35.35±8.21)%、(45.53±16.33)%、(1.45±0.55)次,LABC阴性组则分别为(48.15±6.23)%、(60.33±11.75)%、(1.175±0.25)次,两组比较差异均有统计学意义(P<0.05);FEV1<50%pre LABC阳性患者血清TNF-α、IL-6、IL-8、hs-CRP水平分别为(173.4±15.7)μg/L、(182.3±14.4) ng/L、(58.3±46.4) ng/L、(11.7±9.5) mg/L,FEV1≥50%pre LABC阳性患者的上述各项炎性因子水平分别为(136.3±18.1)μg/L、(125.7±17.5) ng/L、(47.9±21.5) ng/L、(10.8±7.5) mg/L,两组比较差异均有统计学意义(P<0.05)。结论 LABC与肺功能的损害程度及COPD的加重有关,可能是影响COPD患者病情恶化的危险因素。Objective To study the lower airway bacterial colonization（LABC） in elderly patients with stable chronic obstructive pulmonary disease（COPD） in different degrees of lung function and to explore their correlation.Methods A total of 86 patients with stable COPD in the elderly（≥65 years old） were selected, who were diagnosed in the Department of Geriatrics at the Yan＇an Affiliated Hospital of Kunming Medical University from January 2014 to December 2015. The bacteriological quantification of induced sputum or bronchoalveolar lavage fluid（BALF） from the patients were performed. According to the results of LABC, these patients were divided into LABC-positive group and LABC-negative group. Then serum level of interleukin 6（IL-6）, interleukin 8（IL-8）, hypersensitive C-reactive protein（hs-CRP） and tumor necrosis factor-α（TNF-α） were detected by enzyme-linked immunosorbent assay（ELISA）, and forced vital capacity（FVC）, forced expiratory volume in first second（FEV1）, FEV1% predicted value（FEV1%pred）, and FEV1/FVC ratio were measured simultaneously. Pulmonary function and the levels of inflammatory factors were compared between the two groups. Results There were 39 patients with LABC in 86 patients with COPD, and the bacterial colonization rate was 45.35%. The level of FEV1% pred, FEV1/FVC ratio and the number of acute episodes in LABC-positive group were（35.35±8.21）%,（45.53±16.33）%,（1.45±0.55） times, respectively, and the corresponding data in LABC-negative group were（48.15±6.23）%,（60.33±11.75）% and（1.175±0.25） times, respectively; the differences between the two groups were statistically significant（P〈0.05）. The serum level of TNF-α, IL-6, IL-8 and hs-CRP in LABC-positive patients with FEV150%pre were（173.4±15.7） μg/L,（182.3±14.4） ng/L,（58.3±46.4） ng/L and（11.7±9.5） mg/L, respectively, and the corresponding levels of above inflammatory factor in LABC-positive patients with FEV1≥50%pre were（136.3±18.1） μg/

关 键 词：老年 稳定期老年慢性阻塞性肺疾病 下呼吸道细菌定植 炎性因子 肺功能 

分 类 号：R563[医药卫生—呼吸系统]