哮喘-慢性阻塞性肺疾病重叠与慢性阻塞性肺疾病患者下呼吸道感染病原学、气道重塑特征分析  

Analysis of the etiology of lower respiratory tract infections and airway remodeling character-istics in patients with asthma-COPD overlap and COPD

作　　者：祝小燕 张俊 谭传伟 ZHU Xiao-yan;ZHANG Jun;TAN Chuan-wei(Neijiang Shizhong District People's Hospital,Neijiang 641000,China)

机构地区：[1]四川省内江市市中区人民医院,四川内江641000

出　　处：《实用医院临床杂志》2025年第2期167-171,共5页Practical Journal of Clinical Medicine

基　　金：四川省卫生健康委员会科研基金资助项目(编号:22PJ109)。

摘　　要：目的分析哮喘-慢性阻塞性肺疾病重叠(ACO)与慢性阻塞性肺疾病(COPD)呼吸道感染病原学、气道重塑特征。方法选取我院收治的212例COPD或ACO患者,其中ACO组76例,COPD组136例,比较两组一般资料,下呼吸道感染病原学和气道重塑特征,分析病原菌感染、气道重塑与ACO发生的关系。结果两组性别、第一秒用力呼气容积(FEV1)/预计值、慢阻肺评估测试(CAT)评分比较,差异有统计学意义(P<0.05),年龄、吸烟史、体质量指数和FEV1/FVC比较,差异无统计学意义(P>0.05)。76例ACO患者中检测菌株数98例,136例COPD患者中检测菌株数188例。ACO组和COPD组中下呼吸道感染病原学均以革兰阴性杆菌为主,分别占比80.61%和88.30%,两组间革兰阴性杆菌和革兰阳性球菌构成比比较,差异无统计学意义(P>0.05),ACO组真菌构成比高于COPD组(P<0.05);ACO组壁厚下外径比例(TDR%)和气道壁面积占总横截面积比例(WA%)及血清基质金属蛋白酶(MMP)-3、MMP-9、TIMP-1、转换生长因子-β(TGF-β)均高于COPD组(P<0.05);不同病原菌感染ACO及COPD患者气道重塑指标比较,差异有统计学意义(P<0.05),真菌组TDR%和WA%及血清MMP-3、MMP-9、TIMP-1、TGF-β水平均高于革兰阴性杆菌组和革兰阳性球菌组(P<0.05)。真菌感染、MMP-3、TIMP-1、TDR%及WA%是ACO发生的危险因素(P<0.05)。结论ACO与COPD患者下呼吸道感染病原学均以革兰阴性杆菌为主,但ACO患者中真菌构成比例高于COPD患者,ACO患者气道重塑特征更为严重,真菌感染、MMP-3、TIMP-1、TDR%及WA%均与ACO发生有关。Objective To analyze the etiology of respiratory infections and airway remodeling characteristics of asthma chronic obstructive pulmonary disease overlap(ACO)and chronic obstructive pulmonary disease(COPD).Methods A total of 212 patients with COPD or ACO admitted to our hospital were selected.The patients included 76 patients in the ACO group and 136 patients in the COPD group.General information,lower respiratory tract infection etiology and airway remodeling characteristics were compared between the two groups.The relationship between pathogen infection,airway remodeling and ACO occurrence were analyzed.Results There were statistically significant differences in gender,FEV1/predicted value,and COPD Assessment Test(CAT)score between the two groups(P<0.05).However,there was no statistically significant difference in age,smoking history,body mass index and FEV1/FVC(P>0.05).Among the patients,the number of strains detected in 76 ACO patients was 98,and the number of strains detected in 136 COPD patients was 188.The pathogen of lower respiratory tract infections in both ACO and COPD groups was mainly gram-negative bacilli,accounting for 80.61%and 88.30%,respectively.There was no statistically significant difference in the composition ratio of gram-negative bacilli and gram-positive cocci between the two groups(P>0.05),while the fungal composition ratio in the ACO group was higher than that in the COPD group(P<0.05).The TDR%and WA%as well as serum MMP-3,MMP-9,TIMP-1 and TGF-βwere all higher in the ACO group than those in the COPD group(P<0.05).The comparison of airway remodeling indicators in patients with ACO and COPD infected by different pathogens showed statistically significant differences(P<0.05).The TDR%and WA%as well as the serum levels of MMP-3,MMP-9,TIMP-1 and TGF-βwere higher in the fungal group than those in the gram-negative bacteria group and gram-positive cocci group(P<0.05).Fungal infection,MMP-3,TIMP-1,TDR%,and WA%were risk factors for ACO(P<0.05).Conclusions The pathogen of lower respiratory tract

关 键 词：哮喘-慢性阻塞性肺疾病重叠 慢性阻塞性肺疾病 呼吸道感染 病原学 气道重塑 

分 类 号：R563[医药卫生—呼吸系统]