2016—2019年老年AECOPD患者下呼吸道定植菌分布及影响因素分析  

Distribution and influencing factors of lower respiratory tract colonizing bacteria in elderly patients with AECOPD from 2016 to 2019

作　　者：张兰香 孙春鹏[1] 杨华 王倩[1] 宋岳涵 刘倩[1] 凡永军 ZHANG Lanxiang;SUN Chunpeng;YANG Hua;WANG Qian;SONG Yuehan;LIU Qian;FAN Yongjun(Department of Family Medicine,Baoding Second Hospital,Baoding,Hebei 071051,China)

机构地区：[1]保定市第二医院全科医学科,河北保定071051

出　　处：《医学动物防制》2023年第11期1080-1084,共5页Journal of Medical Pest Control

基　　金：河北省医学科学研究课题计划(20200170);保定市科技支撑计划项目(17ZF058)。

摘　　要：目的探究2016—2019年老年慢性肺阻性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者下呼吸道定植菌的分布情况及影响因素。方法选取2016—2019年保定市某医院的600例AECOPD患者作为研究对象,通过痰培养鉴定结果分析其下呼吸道定植菌的分布情况,采用多因素logistic回归分析其下呼吸道感染的影响因素。结果600例AECOPD患者痰样本细菌培养阳性率为33.33%,分离出250株病原菌,革兰阴性杆菌、革兰阳性球菌和真菌占比分别为60.00%、24.00%和16.00%。年龄≥70岁、中性粒细胞(neutrophils,NEU)计数≥7.0×10^(9)/L和CD4^(+)T/CD8^(+)T细胞≤1.4的AECOPD患者下呼吸道感染比例明显升高(χ^(2)=39.647、5.462、13.810,P<0.05);合并糖尿病、机械通气、使用糖皮质激素、住院时间≥20d的AECOPD患者下呼吸道感染比例明显升高(χ^(2)=7.743、4.373、11.079、22.906,P<0.05)。AECOPD患者发生下呼吸道感染的危险因素包括年龄≥70岁、NEU计数≥7.0×10^(9)/L、CD4^(+)T/CD8^(+)T细胞≤1.4、糖尿病、机械通气、糖皮质激素和住院时间≥20d。结论大肠埃希菌、肺炎克雷伯菌等革兰阴性杆菌是AECOPD患者发生下呼吸道感染的主要病原菌,年龄、住院时间、炎性因子、免疫功能、糖尿病史、糖皮质激素使用情况和机械通气均为AECOPD患者发生下呼吸道感染的影响因素。Objective To investigate the distribution and influencing factors of lower respiratory tract colonizing bacteria in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)from 2016 to 2019.Methods Six hundred AECOPD patients from a hospital in Baoding from 2016 to 2019 were selected as research objects,and the distribution of their lower respiratory tract colonizing bacteria was analyzed by the results of sputum culture identification,and the influencing factors of their lower respiratory tract infections were analyzed by multi-factor logistic regression.Results The bacterial culture positive rate of sputum samples from 600 AECOPD patients was 33.33%,and 250 pathogenic bacteria strains were isolated,with Gram-negative bacilli,Gram-positive cocci and fungi accounting for 60.00%,24.00%and 16.00%,respectively.The proportion of lower respiratory tract infections was significantly higher in AECOPD patients aged≥70 years,with neutrophils(NEU)count≥7.0×10^(9)/L and CD4^(+)T/CD8^(+)T cells≤1.4(χ^(2)=39.647,5.462,13.810,P<0.05).The proportion of lower respiratory tract infections was significantly higher in AECOPD patients with combined diabetes,mechanical ventilation,glucocorticoid use,and hospitalization duration≥20d(χ^(2)=7.743,4.373,11.079,22.906,P<0.05).Risk factors for the development of lower respiratory tract infections in patients with AECOPD included age≥70 years,NEU count≥7.0×10^(9)/L,CD4^(+)T/CD8^(+)T cells≤1.4,diabetes,mechanical ventilation,glucocorticoids,and hospitalization duration≥20d.Conclusion Gram-negative bacilli such as Escherichia coli and Klebsiella pneumoniae are the main pathogens responsible for lower respiratory tract infections in patients with AECOPD.Age,duration of hospitalization,inflammatory factors,immune function,history of diabetes,glucocorticoid use and mechanical ventilation are all influential factors in the development of lower respiratory tract infections in AECOPD patients.

关 键 词：慢性肺阻性肺疾病 慢性肺阻性肺疾病急性加重期 病原菌 下呼吸道定植菌 影响因素 大肠埃希菌 分析 

分 类 号：R563.1[医药卫生—呼吸系统]