慢性阻塞性肺疾病下呼吸道菌群地域性差异分析  

Difference in lower respiratory tract flora of patients with chronic obstructive pulmonary disease in different regions

作　　者：高秉睿 陈海燕[1] 冯玥 郭英华[3] 解立新[3] GAO Bing-rui;CHEN Hai-yan;FENG Yue;GUO Ying-hua;XIE Li-xin(Hainan Hospital of PLA General Hospital,Sanya,Hainan 572000,China;不详)

机构地区：[1]解放军总医院海南医院呼吸与危重症医学科,海南三亚572000 [2]佳木斯大学基础医学院,黑龙江佳木斯154007 [3]解放军总医院呼吸学部,北京100089

出　　处：《中华医院感染学杂志》2024年第22期3397-3401,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金专项基金资助项目(82341119)。

摘　　要：目的研究不同地域慢性阻塞性肺疾病(简称慢阻肺)患者下呼吸道菌群差异。方法收集2012年6月-2024年5月在解放军总医院海南医院住院的慢阻肺患者的姓名、年龄、性别、身高、体质量指数(BMI)、吸烟史、合格痰标本以及血清C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)等指标,并根据不同定植菌种进行分层,从而对患者进行差异分析。结果327例慢阻肺患者共成功入组127例,海南组61例,非海南组66例,南北两地患者年龄、性别、BMI、第一秒用力肺活量(FEV_(1))、氧分压(PO_(2))、二氧化碳分压(PCO_(2))和PCT等指标比较,均无统计学差异,但非海南组患者CRP高于海南组(P<0.05);海南组共培养79株病原菌,非海南组共培养95株病原菌。海南组检出率最高的细菌是铜绿假单胞菌、肺炎克雷伯菌和鲍氏不动杆菌;非海南组检出率最高的细菌是肺炎克雷伯菌、铜绿假单胞菌和鲍氏不动杆菌;海南组丰度最高的真菌是黑曲霉菌,非海南组丰度最高的真菌是曲霉菌。结论慢阻肺患者男性多见,中国南北地区慢阻肺患者下呼吸道菌群种类存在差异,热带地区存在一些少见菌种,当地患者入院时的抗菌药物经验性治疗应结合当地常见菌种。OBJECTIVE To observe the difference in lower respiratory tract flora of the patients with chronic obstructive pulmonary disease(COPD).METHODS The patients with COPD who were hospitalized in Hainan Hospital of Chinese PLA General Hospital from Jun.2012 to May 2024 were enrolled in the study.The clinical data,including name,age,gender,height,body mass index(BMI),smoking history,qualified sputum specimens,serum C-reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6),were collected from the patients.The patients were classified based on the species of colonized bacteria so as to analyze the difference.RESULTS Of the 327 patients with COPD,127 were successfully enrolled in the study,61 of whom were assigned as the Hainan group,and 66 were assigned as the non-Hainan group.There were no significant differences in the age,gender,BMI,forced expiratory volume in 1 second(FEV_(1)),partial pressure of oxygen(PO_(2)),partial pressure of carbon dioxide and PCT between the south patients and the north patients,however,the CRP level of the non-Hainan group was higher than that of the Hainan group(P<0.05).Totally 79 strains of pathogens were isolated from the Hainan group,and 95 strains of pathogens were isolated from the non-Hainan group.The isolation rates of Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii were the highest in the Hainan group;the isolation rates of K.pneumoniae,P.aeruginosa and A.baumannii were the highest in the non-Hainan group.Aspergillus niger was the fungus with the highest abundance in Hainan group,and the Aspergillus was the fungus with the highest abundance in the non-Hainan group.CONCLUSIONS The male patients are dominant among the patients with COPD,the non-Hainan and south regions of China vary in the species of lower respiratory tract flora among the COPD patients,some species are less common in the tropical regions.It is necessary to carry out the empirical antibiotic treatment for the patients at admission based on the common species in the local area.

关 键 词：慢性阻塞性肺疾病 下呼吸道菌群 地域性差异 临床评分 菌种差异 

分 类 号：R563[医药卫生—呼吸系统]