维生素D缺乏对支气管扩张患者气道细菌定植及病情严重程度的影响  

Effects of vitamin D deficiency on airway bacterial colonization and severity of disease in patients with bronchiectasis

作　　者：武莉莉[1] 刘春丽[2] 黄河[1] 杨东霞[1] 苏炜欣 施睿[1] 高波[1] 肖稳娣 WU Li-li;LIU Chun-li;HUANG He;YANG Dong-xia;SU Wei-xin;SHI Rui;GAO Bo;XIAO Wen-di(Department of Respiratory Medicine, the Second People 5 Hospital of Shenzhen, Shenzhen 518035, Guangdong,CHINA;Guangzhou Institute of Respiratory Diseases/Department of Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong, CHINA)

机构地区：[1]深圳市第二人民医院呼吸内科,广东深圳518035 [2]广州医科大学附属第一医院呼吸内科/广州呼吸健康研究所,广东广州510120

出　　处：《海南医学》2019年第5期575-579,共5页Hainan Medical Journal

基　　金：广东省深圳市科技创新委员会自由探索项目(编号:JCYJ20160425104021619)

摘　　要：目的探讨维生素D缺乏对支气管扩张患者细菌定植率及病情严重程度的影响。方法选取2016年2月至2017年2月在深圳市第二人民医院呼吸内科住院治疗的支气管扩张患者127例,根据血清25-羟维生素D水平将患者分为三组:A组为维生素D缺乏组(25-羟维生素D≤20 ng/mL),B组为维生素D不足组(25-羟维生素D20.1～30 ng/mL),C组为维生素D充足组(25-羟维生素D 30.1～100 ng/mL)。三组患者分别进行肺功能测定、莱塞斯特咳嗽生命质量问卷(LCQ)评分及Reiff评分,以评估病情严重程度,糖精渡越时间测定了解黏液纤毛清除功能,并行痰及肺泡灌洗液微生物学检查了解细菌定植率。结果 A组患者52例,占40.9%,B组患者47例,占37.0%,C组患者28例,仅占22.1%;A组、B组、C组患者中女性分别占80.8%、70.2%、57.1%,A组明显高于C组,差异有统计学意义(P<0.05),而A组与B组、B组与C组比较,差异均无统计学意义(P>0.05);LCQ评分及Reiff评分三组间比较差异无统计学意义(P>0.05);A、B、C三组患者的第1秒用力呼气容积占预计值百分比(FEV1%预计值)分别为75.0%(IQR 65.3%～85.5%)、96.0%(IQR 78.0%～106.0%)、95.5%(IQR 75.8%～103.8%),差异有统计学意义(P<0.01),A组最低;A、B、C三组患者的细菌定植率分别为23.1%、8.5%、3.6%,差异有统计学意义(P<0.05),A组最高;A、B、C三组患者的糖精渡越时间(STT)分别为(1123.5±25.3) s、(866.3±28.6) s、(694.5±25.6) s,差异有统计学意义(P<0.01),A组最长;维生素D水平与STT之间存在负相关(r=-0.697,P<0.01)。结论支气管扩张患者的维生素D缺乏以女性患者尤为常见;不同维生素D水平支气管扩张患者的咳嗽症状及影像学表现无明显差异,但维生素D缺乏患者具有更差的肺功能,其气道的细菌定植率更高,其机制可能与黏液纤毛清除功能下降有关;维生素D水平与黏液纤毛传输时间呈负相关。Objective To investigate the effect of vitamin D deficiency on bacterial colonization rate and severity of disease in patients with bronchiectasis. Methods A total of 127 patients with bronchiectasis who were hospitalized in the Department of Respiratory Medicine at the Second People’s Hospital of Shenzhen from February 2016 to February 2017 were selected and divided into three groups based on serum 25-hydroxy vitamin D levels: group A was vitamin D deficiency group(25-hydroxy vitamin D ≤ 20 ng/mL), group B was vitamin D insufficient group(25-hydroxy vitamin D in the range of 20.1 ng/mL to 30 ng/mL), group C was vitamin D sufficient group(25-hydroxy vitamin D in the range of 30.1-100 ng/mL). Patients in the three groups were assessed for pulmonary function, the Leicester Cough Questionnaire(LCQ) and modified Reiff score, respectively, to assess the severity of the disease. Saccharin Transit Time(STT) was measured to assess the mucociliary clearance. Microbial cultivation of sputum and bronchoalveolar lavage fluid was performed to calculate the bacterial colonization rates. Results There were 52 patients in group A(40.9%), 47 patients in group B(37.0%), and 28 patients in group C(22.1%). Female patients in group A accounted for 80.8% of patients, which was significantly higher than 57.1% in group C, with statistically significant difference(P<0.05);there was no significant differece between group A and group B(70.2%), and aslo between group B and group C(P>0.05). There were no statistically significant differences among the three groups in LCQ score and modified Reiff score(P>0.05). The Forced Expiratory Volume in 1 second(FEV1%) predicted of patients in group A, B and C were 75.0%(IQR65.3-85.5%), 96.0%(IQR 78.0%-106.0%), and 95.5%(IQR 75.8%-103.8%), respectively(P<0.01), which was the lowest in group A. The bacterial colonization rates of patients in group A, B, and C were 23.1%, 8.5%, and 3.6%, respectively(P<0.05), which was the highest in group A. The STT of patients in group A, B, and C were(1123.5±25.3)

关 键 词：支气管扩张 维生素D缺乏 黏液纤毛清除功能 慢性细菌定植 疾病严重程度 

分 类 号：R562.22[医药卫生—呼吸系统]