支气管哮喘急性发作期患者呼吸道菌群特征及血清MD-2水平、EOS%变化  

Characteristics of respiratory tract flora and changes of serum MD-2 level and EOS%in patients with acute attack of bronchial asthma

作　　者：王菲 钱萌 欧阳怡 薛晓婕 Wang Fei;Qian Meng;Ouyang Yi;Xue Xiaojie(Department of Respiratory Medicine,Central Hospital of Edong Medical Group/Affiliated Hospital of Hubei Institute of Technology,Hubei Province,Huangshi 435000,China)

机构地区：[1]鄂东医疗集团市中心医院/湖北理工学院附属医院呼吸内科,湖北省黄石435000

出　　处：《疑难病杂志》2023年第2期132-137,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：湖北省卫生健康委第三批联合基金立项项目(WJ2019H470)。

摘　　要：目的分析支气管哮喘急性发作期(AEBA)患者血清髓样分化蛋白-2(MD-2)水平、嗜酸性粒细胞百分比(EOS%)变化及与呼吸道菌群特征的关系。方法选取2020年8月—2022年2月鄂东医疗集团市中心医院/湖北理工学院附属医院呼吸内科收治的AEBA患者94例为观察组,另选取医院同期健康体检者94例为健康对照组。通过痰培养明确细菌分布特征。比较革兰阴性菌、革兰阳性菌感染患者临床资料,比较2组及不同病情程度AEBA患者血清MD-2、EOS%水平,Spearman法分析血清MD-2、EOS%与病情程度的相关性,采用Logistic回归分析不同细菌感染类型的危险因素,采用受试者工作特征曲线(ROC)评估血清MD-2、EOS%鉴别细菌感染类型的价值。结果AEBA患者中单纯感染革兰阴性菌63例,单纯感染革兰阳性菌26例,同时感染革兰阴性菌、革兰阳性菌5例。革兰阴性菌感染者病情程度重度比例及血清MD-2、EOS%、降钙素原(PCT)水平高于革兰阳性菌感染者,控制力评分低于革兰阳性菌感染者[χ2(t)/P=1.996/0.046、4.329/<0.001、3.663/<0.001、16.714/<0.001、3.371/<0.001];观察组血清MD-2、EOS%均高于健康对照组(t/P=21.161/<0.001、19.288/<0.001);AEBA患者病情程度越重血清MD-2、EOS%水平越高(F/P=21.601/<0.001、23.783/<0.001)。血清MD-2、EOS%与AEBA患者病情程度均呈正相关(r/P=0.842/<0.001、0.846/<0.001);血清MD-2、EOS%升高是AEBA患者感染革兰阴性菌的危险因素[OR(95%CI)=2.973(1.268~5.443)、3.411(1.752~6.097)]。ROC曲线分析显示,血清MD-2、EOS%及二者联合鉴别AEBA患者细菌感染类型的曲线下面积(AUC)分别为0.778、0.772、0.877,二者联合检测大于单独指标鉴别效能(Z/P=2.118/0.034、2.366/0.018)。结论AEBA患者血清MD-2、EOS%水平异常升高,且病情程度越严重其水平变化越明显,同时可鉴别细菌感染类型。Objective To analyze the changes of serum myeloid differentiation protein-2(MD-2),eosinophil percentage(EOS%)and their relationship with the characteristics of respiratory tract flora in patients with acute attack of bronchial asthma(AEBA).Methods From August 2020 to February 2022,94 patients with AEBA admitted to the Department of Respiratory Medicine of the Central Hospital of Eastern Hubei Medical Group/Affiliated Hospital of Hubei Institute of Technology were selected as the observation group,and 94 patients with physical examination in the same period were selected as the health control group.The distribution characteristics of bacteria were determined by sputum culture.Compare the clinical data of patients with gram-negative and gram-positive bacterial infections,compare the levels of serum MD-2 and EOS%in the two groups and AEBA patients with different degrees of illness,analyze the correlation between serum MD-2 and EOS%and the degree of illness by Spearman method,analyze the risk factors of different types of bacterial infections by logistic regression,and evaluate the value of serum MD-2 and EOS%to identify the types of bacterial infections by using the working characteristic curve(ROC)of subjects.Results Among the AEBA patients,63 were infected with gram-negative bacteria,26 with gram-positive bacteria,and 5 with gram-negative bacteria and gram-positive bacteria.The proportion of patients with gram-negative bacterial infection and the levels of serum MD-2,EOS%and procalcitonin(PCT)were higher than those with gram-positive bacterial infection,and the score of control was lower than those with gram-positive bacterial infection[χ^(2)(t)/P=1.996/0.046,4.329/<0.001,3.663/<0.001,16.714/<0.001,3.371/<0.001].The serum MD-2 and EOS%in the observation group were higher than those in the healthy control group(t/P=21.161/<0.001,19.288/<0.001).The more severe the condition of AEBA patients,the higher the level of serum MD-2 and EOS%(F/P=21.601/<0.001,23.783/<0.001).Serum MD-2 and EOS%were positively correlated wit

关 键 词：支气管哮喘 急性发作 菌群特征 髓样分化蛋白-2 嗜酸性粒细胞百分比 呼吸道感染 

分 类 号：R562.2[医药卫生—呼吸系统]