慢性阻塞性肺疾病合并肺部感染患者病原菌分布及影响因素分析  

Analysis of pathogenic bacteria distribution and influencing factors in patients with chronic obstructive pulmonary disease complicated with pulmonary infection

作　　者：肖海励 魏海霞 张胜勇 韩飞[4] 吴周飞 XIAO Hai-li;WEI Hai-xia;ZHANG Sheng-yong;HAN Fei;WU Zhou-fei(Department of Respiratory and Critical Care Medicine,Zhengzhou Central Hospital,Zhengzhou University,Zhengzhou 450000,China;Department of Respiratory and Critical Care Medicine;Microbiology Department,Xinzheng Public People’s Hospital;Department of Respiratory and Critical Care medicine,Xinxiang First People’s Hospital;Department of Respiratory and Critical Care Medicine,Dengzhou Central Hospital)

机构地区：[1]郑州大学附属郑州中心医院呼吸与危重症医学科,河南郑州450000 [2]新郑市公立人民医院呼吸与危重症医学科 [3]新郑市公立人民医院微生物室 [4]新乡市第一人民医院呼吸与危重症医学科二病区 [5]邓州市中心医院呼吸与危重症医学科

出　　处：《中国病原生物学杂志》2022年第11期1324-1327,1332,共5页Journal of Pathogen Biology

基　　金：“全国重点省区细菌性传染病病原谱流行规律与变异研究”子课题“河南省细菌性传染病病原谱流行规律及变异研究”(No.2018ZX10713003-002-003)。

摘　　要：目的分析本院慢性阻塞性肺疾病合并肺部感染患者病原菌分布及影响因素。方法选取2019-2021年本院呼吸内科收诊的327例慢性阻塞性肺疾病患者,将116例合并肺部感染患者纳为观察组,211例未发生肺部感染的患者纳为对照组。采集患者下呼吸道分泌物进行培养分离,使用自动微生物鉴定系统进行鉴定。检测患者肺功能,对慢性阻塞性肺疾病合并肺部感染不同病原菌的患者肺功能进行比较分析。酶联免疫吸附法检测患者血清细胞因子,分析两组患者表达水平。通过患者相关资料,分析慢性阻塞性肺疾病合并肺部感染的影响因素。结果本研究慢性阻塞性肺疾病合并肺部感染率为35.47%,共培养分离病原菌92株。63.05%为革兰阴性菌,主要包括肺炎克雷伯菌、铜绿假单胞菌。34.78%为革兰阳性菌,主要包括肺炎链球菌、金黄色葡萄球菌,2.17%为真菌。对比感染革兰阴性菌组与感染革兰阳性菌组患者的FEV1(%)值、FEV1/FVC值,差异无统计学意义(P>0.05)。对比观察组与对照组患者的酶联免疫吸附法检测结果,两组患者血清细胞因子表达水平(包括IL-2、IL-6、TNF-α、IFN-α、TGF-β)差异有统计学意义(P<0.05)。慢性阻塞性肺疾病合并肺部感染单因素分析显示,两组患者的年龄、性别、吸烟史、高血压病史、留置导管对比差异无统计学意义。住院时间、机械通气、糖尿病史、雾化吸入、使用抗菌药物种类、长期使用抗菌药物对比差异具有统计学意义。多因素Logistic回归分析显示,住院时间≥15 d、有糖尿病史、长期使用抗菌药物是慢性阻塞性肺疾病合并肺部感染的危险因素,雾化吸入是保护因素。结论慢性阻塞性肺疾病合并肺部感染患者病原菌以革兰阴性菌为主,感染患者的IL-2、IL-6、TNF-α、IFN-α、TGF-β表达水平显著升高,对临床诊断肺部感染具有参考价值。住院时间长、合并糖尿病、长期�Objective The distribution of pathogenic bacteria and its influencing factors in patients with chronic obstructive pulmonary disease complicated with pulmonary infection in our hospital were analyzed.Methods From January 1,2019 to December 31,2021,327 patients with chronic obstructive pulmonary disease admitted to the respiratory department of our hospital were selected.116 patients with chronic obstructive pulmonary disease and pulmonary infection were included in the observation group,and 211 patients without pulmonary infection were included in the control group.The patient’s lower respiratory secretions were collected for culture and isolation,and identified by the automatic microbial identification system.The pulmonary function of patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection were detected and compared.Serum cytokines were detected by enzyme-linked immunosorbent assay,and the expression levels of the two groups were analyzed.The influencing factors of chronic obstructive pulmonary disease(COPD)complicated with pulmonary infection through patient related data were analyzed.Results In this study,the pulmonary infection rate of chronic obstructive pulmonary disease was 35.47%,and 92 strains of pathogenic bacteria were isolated.63.05%were Gram-negative bacteria,mainly including Klebsiella pneumoniae and Pseudomonas aeruginosa.34.78%were Gram-positive bacteria,mainly including Streptococcus pneumoniae and Staphylococcus aureus,and 2.17%were fungi.There was no significant difference in FEV1(%)and FEV1/FVC between gram negative bacteria group and gram positive bacteria group(P>0.05).Comparing the results of enzyme-linked immunosorbent assay in the observation group and the control group,the serum cytokine expression levels(including IL-2,IL-6,TNF-α,IFN-α,TGF-β),the difference was statistically significant(P<0.05).Univariate analysis of chronic obstructive pulmonary disease with pulmonary infection showed that there was no significant difference in age,sex,smoking history,hype

关 键 词：慢性阻塞性肺疾病 肺部感染 病原菌 肺功能 危险因素 

分 类 号：R378[医药卫生—病原生物学]