安徽省某地市级三级医院支气管扩张症病因学调查及微生物学对临床特征的影响  

Etiological investigation,microbiological and clinical characteristics analysis of bronchiectasis in a municipal tertiary hospital in Anhui province

作　　者：吴俊[1] 张玲[2] WU Jun;ZHANG Ling(Department of Respiratory Medicine;Department of Laboratory Medicine,Maanshan Municipal People′s Hospital,Maanshan,Anhui 243000,China)

机构地区：[1]马鞍山市人民医院呼吸科,安徽马鞍山243000 [2]马鞍山市人民医院检验科,安徽马鞍山243000

出　　处：《临床肺科杂志》2022年第12期1899-1903,共5页Journal of Clinical Pulmonary Medicine

基　　金：马鞍山市科技计划项目(No.YL-2015-05)。

摘　　要：目的调查某地市级三级医院支气管扩张症病因学、病原学分布,及微生物学对临床特征的影响。方法选取2016年1月至2020年1月本科支扩患者319例,调查其病因学、病原学及耐药性,分析病原菌对临床特征的影响。结果男性151例,女性168例,特发性(73.98%)是最常见病因,其次为感染后(21.63%)等。共分离90株致病菌,首位是铜绿假单胞菌64株(71.11%),其次为肺炎克雷伯菌9株(10%)等。铜绿假单胞菌对阿米卡星的耐药率最低(4.69%),其次哌拉西林他唑巴坦(15.63%)。病原菌组年平均住院次数、病程、中性粒细胞值、CRP值显著高于阴性组(P<0.01),病原菌更易分离自合并慢阻肺支扩症患者(P<0.01),未分离病原菌患者更易出现咯血(P<0.01)。铜绿假单胞菌组上述指标亦显著高于阴性组(P<0.05),但在咯血及合并慢阻肺上未见统计学差异(P>0.05)。结论本地区支扩以特发性为主,感染后亦占较高比率。致病菌以铜绿假单胞菌为主,氨基糖苷类、哌拉西林他唑巴坦敏感性较高。分离病原菌常提示预后差,应根据药敏结果,积极抗菌治疗,有效管理患者,降低死亡率。Objective To investigate the etiological distribution,microbiological and clinical characteristics of adult bronchiectasis in a municipal tertiary hospital.Methods From January 2016 to January 2020,319 patients diagnosed with bronchiectasis were enrolled to investigate the etiology,pathogen distribution and drug resistance,so as to analyze the influence of pathogens on clinical characteristics and inflammatory indexes.Results The patients with bronchiectasis included 151 males and 168 females.Idiopathic bronchiectasis(73.98%)was the main cause,followed by post infection(21.63%).During the past four years,90 strains of pathogens were isolated,the first was Pseudomonas aeruginosa with 64 strains(71.11%),followed by Klebsiella pneumoniae with 9 strains(10.00%),et al.The resistance rate of Pseudomonas aeruginosa to amikacin was the lowest(4.69%),followed by piperacillin tazobactam(15.63%).The average annual hospitalization times,course of disease,neutrophil count and CRP value in the pathogen group were significantly higher than those in the pathogen negative group(P<0.01).The pathogens were more easily isolated from patients with COPD(P<0.01).Hemoptysis was more likely to occur in patients without pathogen isolation(P<0.01).The above indexes in the Pseudomonas aeruginosa group were also significantly higher than those in the non Pseudomonas aeruginosa group(P<0.05),but there was no significant difference between the above two groups in hemoptysis and bronchiectasis combined COPD(P>0.05).Conclusion The main cause of bronchiectasis in this area is idiopathic,and the post-infection factors still account for a high proportion.Pseudomonas aeruginosa is the main pathogen,and aminoglycosides and piperacillin-tazobactam are more sensitive to it.The isolation of pathogen often indicates poor prognosis.Active antimicrobial therapy should be carried out according to the results of drug sensitivity,in order to effectively manage patients and reduce mortality.

关 键 词：支气管扩张症 病因学 耐药性 铜绿假单胞菌 

分 类 号：R562.22[医药卫生—呼吸系统]