慢性阻塞性肺疾病患者下呼吸道病原菌与死亡影响因素研究  

Study on Pathogens in Lower Respiratory Tract and Influencing Factors of Death in Patients with Chronic Obstructive Pulmonary Disease

作　　者：宋灵洁 李红 程曦[3] Song Lingjie;Li Hong;Cheng Xi(Sichuan Collaborative Innovation Center for Elderly Care and Elderly Health, Chengdu Medical College, Chengdu 610500, China;School of Bioscience and Technology, Chengdu Medical College,Chengdu 610500,China;School of Laboratory Medicine, Chengdu Medical College, Chengdu 610500, China)

机构地区：[1]成都医学院四川养老与老年健康协同创新中心,成都610500 [2]成都医学院生物科学与技术学院,成都610500 [3]成都医学院检验医学院,成都610500

出　　处：《成都医学院学报》2021年第4期477-481,共5页Journal of Chengdu Medical College

基　　金：四川省教育厅自然科学重点项目(No:18ZA0168);成都医学院四川养老与老年健康协同创新中心资助项目(No:19Z12);国家级大学生创新训练计划项目(No:201813705021)。

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)患者下呼吸道病原菌分布与死亡的影响因素,为临床COPD的治疗与预后提供依据。方法选取2018年1月至2019年1月上海市肺科医院住院的COPD患者共110例,对患者进行下呼吸道标本的病原菌分析,明确12例死亡病例的病原菌检出情况以及死亡的影响因素。结果共分离出128株病原菌,主要是革兰阴性菌(69.53%,89/128),其次是革兰阳性菌(18.75%,24/128),真菌检出最少(11.72%,15/128)。检出最多的依次是铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌。这3种菌种使用抗生素后,检出株数明显高于未使用抗生素者。110例患者中,混合感染18例,主要是细菌混合感染;12例死亡病例中混合感染占比58.33%,曾用抗生素占比为83.33%。单因素分析发现,死亡相关的影响因素有4个,即混合感染、使用激素、预防性使用抗生素和病程时期。结论革兰阴性菌是COPD下呼吸道的主要病原菌;死亡病例中混合感染及曾用抗生素比例高;混合感染、使用抗生素、使用激素和病程时期均为COPD患者死亡的影响因素。临床需结合检验结果和影响因素,合理制定治疗方案。Objective To analyze the pathogen types in lower respiratory tract and the influencing factors of death in patients with chronic obstructive pulmonary disease(COPD),so as to provide basis for the treatment and prognosis of COPD.Methods A total of 110 COPD patients hospitalized in Shanghai Pulmonary Hospital from January 2018 to January 2019 were selected.The pathogen samples from lower respiratory tract were analyzed.The pathogens of 12 dead cases and the influencing factors of death were analyzed.Results A total of 128 strains of pathogens were isolated,mainly gram-negative bacteria(69.53%,89/128),followed by gram-positive bacteria(18.75%,24/128),and fungi(11.72%,15/128).Pseudomonas aeruginosa,Acinetobacter baumannii and Klebsiella pneumoniae were the most detected.And the number of detected strains of these three bacteria after antibiotics treatment was greater than that of those before antibiotics treatment.There were 18 cases of mixed infection among 110 patients,mainly bacterial mixed infection.Among the 12 deaths,mixed infections accounted for 58.33%,and history of antibiotics treatment accounted for 83.33%.Univariate analysis revealed four influencing factors associated with COPD mortality,namely,mixed infection,use of hormones,prophylactic use of antibiotics,and stage of disease.Conclusion Gram-negative bacteria are the main pathogens in the lower respiratory tract of COPD patients.The proportion of mixed infection and previous use of antibiotic was high in death cases.Mixed infection,use of hormones and antibiotics,and stage of disease are the influencing factors of death in COPD patients.It is suggested that laboratory results and influencing factors should be combined to formulate an optimum treatment plan.

关 键 词：慢性阻塞性肺疾病 病原菌 影响因素 下呼吸道 死亡 

分 类 号：R117[医药卫生—公共卫生与预防医学]