肺细菌定植对老年肺炎患者免疫功能及气道重塑的影响研究  

Effect of bacterial colonization of the lung on immune function and airway remodeling in elderly patients with pneumonia

作　　者：蒋丕萍[1] 闫磊[1] 周凌[1] JIANG Piping;YAN Lei;ZHOU Ling(Department of Respiratory and Critical Care Medicine,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院呼吸与危重症医学科,北京100049

出　　处：《国际免疫学杂志》2024年第6期617-623,共7页International Journal of Immunology

摘　　要：目的探究肺细菌定植对老年肺炎患者免疫功能及气道重塑的影响。方法选取2021年1月至2022年12月于航天中心医院就诊的129例老年肺炎患者作为研究组,同期选取老年健康体检者135例作为对照组,对肺炎患者痰液进行细菌学定量,根据定植结果分为定植组和非定植组,分析患者细菌分布情况,比较三组免疫功能(CD4^(+)、CD8^(+)以及CD4^(+)/CD8^(+)比值)、炎性因子[肿瘤坏死因子(tumor necrosis factor,TNF)-α、白细胞介素(interleukin,IL)-6、IL-8]、肺功能[用力肺活量(forced lung capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)、1秒率(FEV1/FVC)]以及气道重塑指标[支气管管腔面积(lumen area,LA)/个体表面积(body surface area,BSA)、壁面积(wall area,WA)/BSA、壁厚(wall thickness,WT)/√BSA、吸气相肺体积(lung volume of inspiratory,V_(in))和平均肺密度(mean lung density of inspiratory,MLD_(in))]。结果对照组135例受试者中未检出细菌定植。129例老年肺炎患者中存在74例细菌定植,主要菌群包括铜绿假单胞菌(2.9×10^(7)CFU/mL)、肺炎克雷伯菌(2.1×10^(7)CFU/mL)、卡他莫拉氏菌(1.4×10^(7)CFU/mL)纳入定植组。其余55例肺炎患者无细菌定植纳入非定植组。比较三组免疫功能表明,肺炎定植组、非定植组与对照组血清CD4^(+)占比和CD4^(+)/CD8^(+)比值依次降低,CD8^(+)占比依次增高[(25.12±5.35)%比(31.51±8.13)%比(38.53±4.89)%;(36.48±8.12)比(32.16±7.46)比(24.59±5.41);(0.69±0.13)%比(0.98±0.15)%比(1.57±0.23)%,F值分别为129.87、80.58、552.67,P值均<0.05]。比较三组炎性因子表明,肺炎定植组、非定植组与对照组TNF-α、IL-6和IL-8表达依次降低[ng/L:(30.16±4.21)比(24.46±3.59)比(8.46±2.15);(31.26±4.86)比(21.98±4.02)比(7.61±1.56);(20.49±3.14)比(17.75±3.10)比(15.12±1.52),F值分别为1276.37、1263.51、118.13,P值均<0.05]。对比三组肺功能表明,三组受试者FVC、FEV1和FEV1/FVC之间差异均Objective To investigate the effect of bacterial colonization of the lung on immune function and airway remodeling in elderly patients with pneumonia.Methods Total of 129 elderly patients with pneumonia who attended the Aerospace Center Hospital from January 2021 to December 2022 were prospectively enrolled,and another 135 elderly health check-ups were concurrently enrolled as control group.Patients with pneumonia were classified into colonization group and non-colonization group according to the bacteriological examination of sputum.The distribution of bacterial pathogens was analyzed.Then comparison was conducted among three groups,including immunological function indicators(CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)),inflammatory indices[tumour necrosis factor(TNF)-α,interleukin(IL)-6,IL-8],lung function parameters[forced lung capacity(FVC),forced expiratory volume in the first second(FEV1),FEV1/FVC],and airway remodelling indices[lumen area(LA)/body surface area(BSA),wall area(WA)/BSA,wall thickness(WT)/√BSA,inspiratory volume(V_(in)),mean lung density at end deep inspiratory phase(MLD_(in))].Results Bacterial colonization was detected in none of 135 healthy controls,while in 74 of 127 patients with pneumonia.The pathogenic bacterial isolates were mainly Pseudomonas aeruginosa(2.9×10^(7)CFU/mL),Klebsiella pneumoniae(2.1×10^(7)CFU/mL),and Moraxella catarrhalis(1.4×10^(7)CFU/mL).Patients with bacterial colonization(74 cases)were enrolled into colonization group,and the rest(55 cases)were set as non-colonization group.Serum CD4^(+)percentage and CD4^(+)/CD8^(+)sorted in a descending order among three groups were colonization group,non-colonization group and control group,conversely,serum CD8^(+)percentage sorted in a descending order among three groups were control group,non-colonization group and colonization group[(25.12±5.35)%vs(31.51±8.13)%vs(38.53±4.89)%;(36.48±8.12)vs(32.16±7.46)vs(24.59±5.41);(1.57±0.23)%vs(0.98±0.15)%vs(0.69±0.13)%,F values were 3.08,17.77,4.93,all P values<0.05].Serum expression

关 键 词：细菌定植 肺炎 气道重塑 免疫功能 肺功能 

分 类 号：R563.1[医药卫生—呼吸系统]