• 山西醫(yī)科大學(xué)第一醫(yī)院呼吸內(nèi)科(山西太原 030001);

目的 探討慢性阻塞性肺疾病急性加重期(AECOPD)患者的病原學(xué)特點及其與肺功能的關(guān)系。方法 對64例AECOPD患者行肺功能測定,痰細(xì)菌定量、定性培養(yǎng)和藥物敏感試驗以及血清支原體、衣原體抗體檢測。根據(jù)肺功能第一秒用力呼氣容積占預(yù)計值百分比(FEV1%pred)將患者分為三組:Ⅰ組(50%≤FEV1 lt;80%pred)、Ⅱ組(30%≤FEV1 lt;50%pred)和Ⅲ組(FEV1 lt;30%pred);同時根據(jù)痰培養(yǎng)結(jié)果將感染細(xì)菌分為A(G+菌),B(除C類以外的G-菌),C(不動桿菌、腸桿菌及假單胞菌),D痰菌陰性四類。比較三組患者肺功能損害程度與感染細(xì)菌種類之間的關(guān)系。結(jié)果 ⑴64例行痰定量培養(yǎng)患者感染細(xì)菌以肺炎鏈球菌、腸桿菌、卡他莫拉菌及假單胞菌為主。其中38例同時行痰定性培養(yǎng)的住院患者以肺炎鏈球菌、表皮葡萄球菌、不動桿菌和腸桿菌為多,且多為混合感染。⑵痰定量與定性培養(yǎng)均為Ⅰ組患者以痰菌陰性為主,Ⅲ組患者以耐藥A類菌及C類菌為主,P分別 lt;0.01和0.05。⑶29.4%的AECOPD患者有支原體或衣原體感染。結(jié)論 AECOPD患者感染細(xì)菌種類與肺功能損害的嚴(yán)重程度密切相關(guān),肺功能損害越嚴(yán)重,耐藥肺炎鏈球菌等G+球菌、不動桿菌、腸桿菌及假單胞菌分離率越高。

引用本文: 許建英,李筱妍,杜永成,楊麗莉,王淑峰,王紅. 慢性阻塞性肺疾病急性加重期病原學(xué)與肺功能關(guān)系的研究. 中國呼吸與危重監(jiān)護(hù)雜志, 2007, 6(2): 88-93. doi: 復(fù)制

1. 趙鳴武.重視對慢性阻塞性肺疾病急性加重的病因?qū)W及其對策的研究.中國呼吸與危重監(jiān)護(hù)雜志,2004,3:67.
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3. Monso E,Ruiz J,Rosell A,et al.Bacterial infection in chronic obstructive pulmonary disease.Am J Respir Crit Care Med,1995,152:1316-1320.
4. 中華醫(yī)學(xué)會呼吸病學(xué)分會慢性阻塞性肺疾病學(xué)組.慢性阻塞性肺疾病診治指南.中華內(nèi)科雜志,2002,41:640-646.
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9. 霍建民,楊光,張俊梅,等.COPD患者急性加重期細(xì)菌學(xué)與肺功能關(guān)系的初步研究.中國急救醫(yī)學(xué),2002,22:35.
10. 林英翔,王辰,杜小玲,等.慢性阻塞性肺病急性加重期痰細(xì)菌學(xué)培養(yǎng)與肺功能的關(guān)系.中華醫(yī)院感染學(xué)雜志,2002,12:182-183.
11. 劉又寧,陳民鈞,趙鐵梅,等.中國城市成人社區(qū)獲得性肺炎665例病原學(xué)多中心調(diào)查.中華結(jié)核和呼吸雜志,2006,29:3-8.
12. 楊文杰,陶家駒,衛(wèi)京平,等.慢性阻塞性肺疾病急性發(fā)作病原學(xué)及臨床特點分析.中華臨床醫(yī)藥,2003,4:49-51.
13. 何禮賢,李錫瑩.下呼吸道感染的細(xì)菌學(xué)診斷方法評價.中華結(jié)核和呼吸雜志,1987,10:183-186.
14. Kilbourn JP,Campbell RA,Grach JL,et al.Quantitative bacteriology of sputum.Am Rev Respir Dis,1968,98:810-818.
15. Hill AT,Campbell EJ,Hill SL,et al.Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis.Am J Med,2000,109:288-295.
16. Sethi S,Muscarella K,Evans N,et al.Airway inflammation and etiology of acute exacerbations of chronic bronchitis.Chest,2000,118:1557-1565.
17. Miravitlles M.Exacerbations of chronic obstructive pulmonary disease:when are bacteria important? Eur Respir J,2002,36:9s-19s.
  1. 1. 趙鳴武.重視對慢性阻塞性肺疾病急性加重的病因?qū)W及其對策的研究.中國呼吸與危重監(jiān)護(hù)雜志,2004,3:67.
  2. 2. Eller J,Ede A,Schaberg T,et al.Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function.Chest,1998,113:1542-1548.
  3. 3. Monso E,Ruiz J,Rosell A,et al.Bacterial infection in chronic obstructive pulmonary disease.Am J Respir Crit Care Med,1995,152:1316-1320.
  4. 4. 中華醫(yī)學(xué)會呼吸病學(xué)分會慢性阻塞性肺疾病學(xué)組.慢性阻塞性肺疾病診治指南.中華內(nèi)科雜志,2002,41:640-646.
  5. 5. 熊彬,王榮麗,曹乃清,等.慢性阻塞性肺疾病急性加重期痰細(xì)菌培養(yǎng)與肺功能關(guān)系探討.實用心腦肺血管病雜志,2004,12:83-85.
  6. 6. Miravitlles M,Espinosa C,F(xiàn)ernandez-Laso E,et al.Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD.Study Group of Bacterial Infection in COPD.Chest,1999,116:40-46.
  7. 7. 馬春玲,張紀(jì)云,夏麗華.口痰細(xì)菌定量培養(yǎng)方法及其應(yīng)用.臨沂醫(yī)專學(xué)報,1995,17:293-294.
  8. 8. 陳慧生,李慶棣,梁冰.簡化痰細(xì)菌定量培養(yǎng)法的臨床應(yīng)用和評價.臨床薈萃,1994,9:570-572.
  9. 9. 霍建民,楊光,張俊梅,等.COPD患者急性加重期細(xì)菌學(xué)與肺功能關(guān)系的初步研究.中國急救醫(yī)學(xué),2002,22:35.
  10. 10. 林英翔,王辰,杜小玲,等.慢性阻塞性肺病急性加重期痰細(xì)菌學(xué)培養(yǎng)與肺功能的關(guān)系.中華醫(yī)院感染學(xué)雜志,2002,12:182-183.
  11. 11. 劉又寧,陳民鈞,趙鐵梅,等.中國城市成人社區(qū)獲得性肺炎665例病原學(xué)多中心調(diào)查.中華結(jié)核和呼吸雜志,2006,29:3-8.
  12. 12. 楊文杰,陶家駒,衛(wèi)京平,等.慢性阻塞性肺疾病急性發(fā)作病原學(xué)及臨床特點分析.中華臨床醫(yī)藥,2003,4:49-51.
  13. 13. 何禮賢,李錫瑩.下呼吸道感染的細(xì)菌學(xué)診斷方法評價.中華結(jié)核和呼吸雜志,1987,10:183-186.
  14. 14. Kilbourn JP,Campbell RA,Grach JL,et al.Quantitative bacteriology of sputum.Am Rev Respir Dis,1968,98:810-818.
  15. 15. Hill AT,Campbell EJ,Hill SL,et al.Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis.Am J Med,2000,109:288-295.
  16. 16. Sethi S,Muscarella K,Evans N,et al.Airway inflammation and etiology of acute exacerbations of chronic bronchitis.Chest,2000,118:1557-1565.
  17. 17. Miravitlles M.Exacerbations of chronic obstructive pulmonary disease:when are bacteria important? Eur Respir J,2002,36:9s-19s.