实用老年医学

实用老年医学 ›› 2022, Vol. 36 ›› Issue (12): 1255-1258.doi: 10.3969/j.issn.1003-9198.2022.12.017

• 临床研究 • 上一篇    下一篇

老年慢性阻塞性肺疾病急性加重病人病原体分布特点的单中心回顾性研究

张静, 谭焰, 雷靖, 高琳, 葛以跃, 金佳佳, 王丽, 王小平   

  1. 210006 江苏省南京市,南京医科大学附属南京医院(南京市第一医院)呼吸与危重症医学科(张静,谭焰,雷靖,高琳,金佳佳,王丽);普外科(王小平);
    210009 江苏省南京市,江苏省疾病预防控制中心国家卫生健康委员会肠道病原微生物重点实验室(葛以跃)
  • 收稿日期:2022-06-23 出版日期:2022-12-20 发布日期:2022-11-30
  • 通讯作者: 王小平,Email: XPHDLD2013@163.com
  • 基金资助:
    国家自然科学基金资助项目(82100095)

Single center retrospective study on the distribution of pathogens in elderly patients with acute exacerbation of chronic obstructive pulmonary disease

ZHANG Jing, TAN Yan, LEI Jing, GAO Lin, GE Yi-yue, JIN Jia-jia, WANG Li, WANG Xiao-ping   

  1. ZHANG Jing, TAN Yan, LEI Jing, GAO Lin, JIN Jia-jia, WANG Li. Department of Respiratory and Critical Care Medicine; WANG Xiao-ping. Department of Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China;
    GE Yi-yue. NHG Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
  • Received:2022-06-23 Online:2022-12-20 Published:2022-11-30

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摘要： 目的 了解老年慢性阻塞性肺疾病急性加重(AECOPD)病人病原体分布特点及病原学相关性,以指导临床合理使用抗生素及激素。 方法 回顾性分析2019年1月至2020年1月期间南京市第一医院收治的老年AECOPD病人共111例,收集血常规中嗜酸性粒细胞、中性粒细胞、淋巴细胞计数、CRP、红细胞沉降率(ESR)等基本资料,并进一步收集合格痰荧光定量PCR病原学,同时了解AECOPD病人的病原学分布,并分析病原学之间的相关性。 结果 AECOPD病人病原学阳性组与阴性组比较,ESR、心血管疾病比例差异有统计学意义。AECOPD病人中病原体检出率前5位分别为EB病毒(21.6%)、流感嗜血杆菌(19.8%)、肺炎链球菌(17.1%)、单纯疱疹病毒(14.4%)、甲型流感病毒(14.4%)。甲型流感病毒检出率与乙型流感病毒和曲霉菌相关(P<0.05);呼吸道合胞病毒的检出率与念珠菌、卡他莫拉菌、肺炎链球菌和流感嗜血杆菌相关(P<0.05);大肠埃希氏菌的检出率与鼻病毒、腺病毒、肺炎克雷伯菌和鲍曼不动杆菌相关(P<0.05);念珠菌检出率与卡他莫拉菌及铜绿假单胞菌相关(P<0.05);人冠状病毒检出率与流感嗜血杆菌、单纯疱疹病毒和肺炎链球菌相关(P<0.05)。 结论 老年AECOPD多由细菌和病毒混合感染等诱发。通过分析老年AECOPD病人的病原体,有助于指导抗生素合理使用。

关键词: 慢性阻塞性肺疾病, 荧光定量PCR, 病原学

Abstract: Objective To explore the distribution and correlation of pathogens in the elderly patients with AECOPD, so as to guide the rational use of antibiotics and hormones in clinic. Methods A total of 111 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to Nanjing First Hospital from January 2019 to January 2020 were retrospectively analyzed. The basic data such as eosinophil, neutrophil and lymphocyte count, the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate(ESR )in blood routine examination were collected. Further, the pathogens were qualified by sputum fluorescence quantitative polymerase chain reaction, and the pathogens distribution was analyzed. Results The level of ESR and the ratio of cardiovascular diseases showed significant differences between the pathogen-positive group and pathogen-negative group. In this study, the top five pathogens in AECOPD patients were EB virus (21.6%), Haemophilus influenzae (19.8%), Streptococcus pneumoniae (17.1%), herpes simplex virus (14.4%), influenza A virus (14.4%). The detection rate of influenza A virus was correlated with influenza B virus and Aspergillus (P<0.05); The detection rate of respiratory syncytial virus was correlated with Candida, Moraxella catarrholis, Streptococcus pneumoniae and Haemophilus influenzae (P<0.05); The detection rate of Escherichia coli was correlated with rhinovirus, adenovirus, Klebsiella pneumoniae and Acinetobacter baumannii (P<0.05); The detection rate of Candida was correlated with that of Moraxella catarrholis and Pseudomonas aeruginosa (P<0.05); The detection rate of human coronavirus was correlated with Haemophilus influenzae, herpes simplex virus and Streptococcus pneumoniae (P<0.05). Conclusions AECOPD are mostly induced by different pathogens, especially mixed infection of bacteria and virus. It is helpful to guide the rational use of antibiotics by analyzing the etiological characteristics in the elderly patients with AECOPD.

Key words: chronic obstructive pulmonary disease, fluorescence quantitative PCR, pathogen

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