天津部分地区AECOPD住院患者血清MP-IgM阳性检出情况及临床特征分析  

Serum MP-IgM positive detection and clinical characteristics of AECOPD inpatients in some areas of Tianjin

作　　者：曹金钟[1] 李津娜 曹洁[2] 李志刚 林红[4] 陈惠[5] 张明生[6] 顾剑玲[7] 郑洪[8] 李楠[1] 周玉中[9] 赵年昆 谭效锋[11] 张玉华 章学毓[13] 李冠华[14] 李立宇[15] 高静珍[15] 张纳新[16] 魏葆琳[17] 易海峰[18] 刘贵颖[19] CAO Jinzhong;LI Jin-na;CAO Jie(Department of Respiration,Tianjin Third Central Hospita Branchl,Tianjin 300250,China)

机构地区：[1]天津市第三中心医院分院呼吸科,天津300250 [2]天津医科大学总医院呼吸与危重症医学科 [3]天津医科大学总医院滨海医院呼吸科 [4]天津大港油田总医院呼吸科 [5]天津市东丽医院呼吸科 [6]天津医科大学静海临床学院呼吸科 [7]天津市职业病防治院(天津市工人医院)呼吸科 [8]天津市第一中心医院呼吸科 [9]天津中医药大学蓟州区人民医院中西医结合呼吸内科 [10]天津市滨海新区大港医院呼吸科 [11]天津市天津医院普通内科 [12]武警特色医学中心呼吸与重症医学科 [13]天津市人民医院呼吸科 [14]天津市胸科医院呼吸与危重症医学科 [15]天津市第四中心医院呼吸科 [16]天津市第三中心医院呼吸科 [17]天津中医药大学第二附属医院呼吸科 [18]天津港口医院呼吸内科 [19]天津中医药大学第一附属医院呼吸科

出　　处：《中国实验诊断学》2020年第9期1439-1444,共6页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨天津部分地区慢性阻塞性肺疾病急性加重期(AECOPD)住院患者血清肺炎支原体抗体IgM(MP-IgM)的阳性检出率及其临床特征。方法前瞻性纳入2015年4月至2016年4月天津19家二、三级医疗机构因慢性阻塞性肺疾病(慢阻肺)急性加重住院的患者,采用酶联免疫吸附试验(ELISA)法检测患者入院时及出院前双份血清MP-IgM,统计AECOPD住院患者的MP-IgM阳性检出率,并对一系列相关因素进行Logistic回归分析。结果(1)通过双份血清标本MP-IgM检测分析,本地区部分区域内AECOPD住院患者的MP-IgM阳性检出率为14.35%。(2)MP-IgM阳性检出与阴性检出的AECOPD患者间比较,呼吸频率、部分伴随症状及体征差异程度(咯脓性痰、呼吸困难加重、呼吸急促、心动过速、乏力、运动耐力下降、失眠)、稳定期是否坚持家庭氧疗、稳定期是否坚持应用吸入性糖皮质激素联合长效β2受体激动剂(ICS/LABA)、是否频繁急性加重等因素差异具有统计学意义(Z/χ^2值为-3.481~17.597,均为P<0.05)。(3)多因素Logistics回归分析显示:乏力(OR值为1.783,95%CI:1.094-2.972,P<0.05)、运动耐力下降(OR值为2.153,95%CI:1.234-3.756,P<0.01)、稳定期家庭氧疗(OR值为0.449,95%CI:0.250-0.805,P<0.01)、频繁急性加重(OR值为0.389,95%CI:0.222-0.681,P<0.01)为AECOPD住院患者MP感染的影响因素。结论肺炎支原体感染在天津部分地区是导致慢性阻塞性肺疾病患者急性加重的重要原因之一。AECOPD住院患者MP感染表现为相对明显的乏力及运动耐力下降。稳定期实施长程家庭氧疗或可降低AECOPD住院患者MP感染风险;肺炎支原体可能不是频繁急性加重COPD患者肺部微生态环境中的主要成分。Objective To investigate the positive detection rate of serum Mycoplasma pneumoniae antibody IgM(MP-IgM)and the clinical characteristics in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in some areas of Tianjin.Methods 683inpatients with AECOPD were prospectively included who were admitted to 19hospitals of Class 2and 3in Tianjin during April 2015and April 2016.Double ELISA tests were used to determine the level of MP-IgM when the patients were hospitalized and discharged.Infection rate among AECOPD inpatients was calculated.A bunch of coefficients were included into Logistic regression model.Results(1)The ELISA results showed that the infection rate of MP among local AECOPD inpatients were 14.35%.(2)Comparing MP-infected AECOPD inpatients with non-MP-infected AECOPD inpatients,significant coefficients included breath frequency,difference in simultaneous phenomenon and sign such as purulent sputhum,exacerbation of dyspnea,polypnea,tachycardia,weakness in physical strength,weakening in endurance and insomnia,whether domiciliary oxygen therapy is taken during stable phase,whether inhaled cortisteroid/long-actingβ2receptor agonist(ICS/LABA)is used during stable phase,and whether frequent acute exacerbation occurs(Z/χ^2:-3.481~17.597,P<0.05).(3)Multiple Logistic regression showed significant coefficients as follows:weakness in physical strength(OR:1.783,95%CI:1.094-2.972,P<0.05),weakening in endurance(OR:2.153,95%CI:1.234-3.756,P<0.01),whether domiciliary oxygen therapy is taken during stable phase(OR:0.449,95%CI:0.250-0.805,P<0.01),frequent acute exacerbation(OR:0.389,95%CI:0.222-0.681,P<0.01).Conclusion MP infection is among the important reasons that lead to AECOPD in some areas of Tianjin.Inpatients with AECOPD experienced significant weakness in physical strength and weakening in endurance.Patients who took Long-term domiciliary oxygen therapy during stable phase may reduce the risk of MP infection in AECOPD patients.MP may not be the main component of Respirator

关 键 词：肺疾病 慢性阻塞性 急性加重 肺炎支原体 危险因素 

分 类 号：R563[医药卫生—呼吸系统]