慢阻肺急性加重期感染病原菌分布与机体免疫功能检测及其临床意义
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摘要
目的探讨慢阻肺急性加重期(AECOPD)患者感染病原菌分布及机体免疫功能变化,并分析其相关危险因素。方法 2016年9月-2017年11月在本院呼吸内科住院的AECOPD患者100例,于入院第2、3、4 d留痰标本行病原学检查;采集患者外周静脉血,采用流式细胞术检测树突状细胞亚群水平;采用罗氏Cobas c 501生化分析仪测定免疫球蛋白M(IgM)、免疫球蛋白G(IgG)和免疫球蛋白A(IgA);使用肺功能仪检查患者的肺功能;采用多因素Logistic回归分析法分析AECOPD发生危险因素。实验设同期体检的健康者100例作对照。结果 100例AECOPD患者痰培养细菌阳性68例,阳性率68.00%。共分离出细菌68株,其中革兰阴性菌43株(占63.24%),革兰阳性菌25株(占36.76%)。与对照组比较,AECOPD中的GOLDⅠ、Ⅱ、Ⅲ-Ⅳ组患者血FEV1百分比、FEV1/FVC比值及IgM、IgA、IgG水平均显著降低(均P<0.05),mDCs和pDCs百分比及mDCs/pDCs比值均显著升高(均P<0.05)。且随着病情的加重,FEV1百分比、FEV1/FVC比值及IgM、IgA、IgG水平持续下降(均P<0.05),mDCs和pDCs百分比及mDCs/pDCs比值持续升高(均P<0.05)。多因素Logistic回归分析显示,年龄、有慢性疾病史、导管留置和住院时间长均是慢阻肺患者细菌感染的独立危险因素。结论 AECOPD患者肺功能、免疫功能均与病情的严重程度相关,年龄、合并慢性疾病、住院时间及导管留置等为AECOPD发生的危险因素,可为临床诊断及治疗提供参考。
Objectives To investigate the distribution of pathogens and immune function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and to analyze related risk factors. Methods Clinical data on 100 patients with AECOPD admitted to this Hospital from September 2016 to November 2017 were collected. One hundred healthy people who underwent a physical examination during the same period served as the control group. Specimens from patients with AECOPD were pathologically examined on day 2, 3, and 4 of hospitalization. Peripheral venous blood was collected from patients, and the level of dendritic cell subsets was detected using flow cytometry. Levels of immunoglobulin M(IgM), immunoglobulin G(IgG), and immunoglobulin A(IgA) were determined using a Roche Cobas c 501 biochemical analyzer. Lung function was tested using spirometry. Risk factors for AECOPD were analyzed using multivariate logistic regression analysis. The 100 healthy controls underwent the same physical examination as the patients. Results A total of 68 strains of bacteria were isolated and cultured from 100 patients with AECOPD. Of those, 43(63.24%) were strains of Gram-negative bacteria, while 25(36.76%) were strains of Gram-positive bacteria. Compared to the control group, patients with AECOPD that was GOLD grades I, II, or III-IV had a significantly lower FEV1 and FEV1/FVC ratio, significantly lower levels of IgM, IgA, and IgG, a significantly higher percentage of mDCs and pDCs, and a significantly higher ratio of mDCs/pDCs(F=536.241, 299.541, 3898.002, 1782.574, 209.315, 198.087, 243.801, and 145.502, P<0.05, for all). FEV1, the FEV1/FVC ratio, and levels of IgM, IgA, and IgG continued to decrease as the severity of AECOPD increased(P<0.05), and the percentage of mDCs and pDCs and the ratio of mDCs/pDCs continued to increase(P<0.05 for all). Patient age, a history of chronic disease, an indwelling catheter, and the duration of hospitalization were independent risk factors for development of an infection in patients with chronic obstructive pulmonary disease. Conclusion Lung function and immune function in patients with AECOPD are related to the severity of the disease. Age, chronic disease, duration of hospitalization, and an indwelling catheter are risk factors for infection in AECOPD. These findings can provide a reference for clinical diagnosis and treatment.
Objectives To investigate the distribution of pathogens and immune function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and to analyze related risk factors. Methods Clinical data on 100 patients with AECOPD admitted to this Hospital from September 2016 to November 2017 were collected. One hundred healthy people who underwent a physical examination during the same period served as the control group. Specimens from patients with AECOPD were pathologically examined on day 2, 3, and 4 of hospitalization. Peripheral venous blood was collected from patients, and the level of dendritic cell subsets was detected using flow cytometry. Levels of immunoglobulin M(IgM), immunoglobulin G(IgG), and immunoglobulin A(IgA) were determined using a Roche Cobas c 501 biochemical analyzer. Lung function was tested using spirometry. Risk factors for AECOPD were analyzed using multivariate logistic regression analysis. The 100 healthy controls underwent the same physical examination as the patients. Results A total of 68 strains of bacteria were isolated and cultured from 100 patients with AECOPD. Of those, 43(63.24%) were strains of Gram-negative bacteria, while 25(36.76%) were strains of Gram-positive bacteria. Compared to the control group, patients with AECOPD that was GOLD grades I, II, or III-IV had a significantly lower FEV1 and FEV1/FVC ratio, significantly lower levels of IgM, IgA, and IgG, a significantly higher percentage of mDCs and pDCs, and a significantly higher ratio of mDCs/pDCs(F=536.241, 299.541, 3898.002, 1782.574, 209.315, 198.087, 243.801, and 145.502, P<0.05, for all). FEV1, the FEV1/FVC ratio, and levels of IgM, IgA, and IgG continued to decrease as the severity of AECOPD increased(P<0.05), and the percentage of mDCs and pDCs and the ratio of mDCs/pDCs continued to increase(P<0.05 for all). Patient age, a history of chronic disease, an indwelling catheter, and the duration of hospitalization were independent risk factors for development of an infection in patients with chronic obstructive pulmonary disease. Conclusion Lung function and immune function in patients with AECOPD are related to the severity of the disease. Age, chronic disease, duration of hospitalization, and an indwelling catheter are risk factors for infection in AECOPD. These findings can provide a reference for clinical diagnosis and treatment.
引文
[1] 关晶,李建民.无创正压机械通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭患者疗效观察[J].湖南师范大学学报(医学版),2018,15(3):41-3.
[2] 马丽, 文仲光. 降钙素原和高敏C反应蛋白检测在老年慢性阻塞性肺疾病急性加重期的意义[J]. 实用老年医学, 2016,30(5):434-5.
[3] 柳威,陈荣昌.慢性阻塞性肺疾病诱导痰细胞分类特点及其与治疗反应性的相关性分析[J].中国呼吸与危重监护杂志,2016,15(6):537-41.
[4] 池峰, 张舒, 姚晓阳,等. 慢阻肺患者急性加重期病原菌分布及其降钙素原水平分析[J]. 临床肺科杂志, 2016, 21(11):1962-4.
[5] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南[J]. 中华内科杂志, 2002, 41(9):453-60.
[6] Stoll P, Baehker A, Ulrich M, et al. Upregulation of the high-affinity IgE receptor on plasmacytoid dendritic cells in severe COPD[J]. Eur Respirat, 2015, 46(suppl 59):PA3614.
[7] 李晓平,刘冀,杨发满,等.哮喘-慢阻肺重叠综合征与慢阻肺患者中性粒细胞明胶酶相关脂质运载蛋白的差异性研究[J].中国病原生物学杂志,2018,13(3):306-10.
[8] 周红.氨溴索对双水平气道正压通气治疗的老年AECOPD患者免疫功能及肺功能的影响[J].实用临床医药杂志,2017,21(3):158-60.
[9] 安冀东, 霍建民. 慢性阻塞性肺疾病急性加重的病原学进展及临床意义[J]. 医学综述, 2017, 23(5):944-7.
[10] 刘培培. 慢性阻塞性肺疾病的综合评估与外周血淋巴细胞免疫分型的关系[D]. 长春:吉林大学, 2016.
[11] 李乾兵, 陈俊, 徐裕丰,等. COPD患者T淋巴细胞亚群比例及其与BODE指数和急性加重风险的相关性[J]. 皖南医学院学报, 2017, 36(3):224-7.
[12] 刘雪青. 树突状细胞与慢性阻塞性肺疾病关系的探讨[D]. 济宁:济宁医学院, 2015.
[13] 刘雪青, 姜鲁宁, 宋敏. 树突状细胞对慢性阻塞性肺疾病的诊断意义[J]. 中国免疫学杂志, 2015,31(5):678-82.
[14] 黄颖锋,孙广信,周丽娟,等.苏黄止咳胶囊对于慢性阻塞性肺疾病急性加重期患者的临床疗效[J].世界中医药,2017,12(9):2023-7.
[15] Xiong Y, Gao S, Luo G, et al. Increased circulating autoantibodies levels of IgG, IgA, IgM against cytokeratin 18 and cytokeratin 19 in chronic obstructive pulmonary disease[J]. Arch Medl Res, 2017, 48(1):79-87.
[16] 陈昌枝,邵有和,覃家盟,等.慢性阻塞性肺疾病患者免疫球蛋白的表达及与肺功能的关系[J].临床肺科杂志,2015,20(8):1404-6.
[17] 李允, 罗裕文, 郑晶晶,等. 慢性阻塞性肺疾病急性加重期住院患者呼吸道病毒病原学分布及危险因素分析[J]. 中国现代医学杂志, 2016, 26(6):80-4.
[18] 龚峰, 张晓调, 陈显静,等. 慢性阻塞性肺疾病急性加重患者相关病毒感染的危险因素分析[J]. 中华医院感染学杂志, 2017, 27(4):800-3.
[2] 马丽, 文仲光. 降钙素原和高敏C反应蛋白检测在老年慢性阻塞性肺疾病急性加重期的意义[J]. 实用老年医学, 2016,30(5):434-5.
[3] 柳威,陈荣昌.慢性阻塞性肺疾病诱导痰细胞分类特点及其与治疗反应性的相关性分析[J].中国呼吸与危重监护杂志,2016,15(6):537-41.
[4] 池峰, 张舒, 姚晓阳,等. 慢阻肺患者急性加重期病原菌分布及其降钙素原水平分析[J]. 临床肺科杂志, 2016, 21(11):1962-4.
[5] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南[J]. 中华内科杂志, 2002, 41(9):453-60.
[6] Stoll P, Baehker A, Ulrich M, et al. Upregulation of the high-affinity IgE receptor on plasmacytoid dendritic cells in severe COPD[J]. Eur Respirat, 2015, 46(suppl 59):PA3614.
[7] 李晓平,刘冀,杨发满,等.哮喘-慢阻肺重叠综合征与慢阻肺患者中性粒细胞明胶酶相关脂质运载蛋白的差异性研究[J].中国病原生物学杂志,2018,13(3):306-10.
[8] 周红.氨溴索对双水平气道正压通气治疗的老年AECOPD患者免疫功能及肺功能的影响[J].实用临床医药杂志,2017,21(3):158-60.
[9] 安冀东, 霍建民. 慢性阻塞性肺疾病急性加重的病原学进展及临床意义[J]. 医学综述, 2017, 23(5):944-7.
[10] 刘培培. 慢性阻塞性肺疾病的综合评估与外周血淋巴细胞免疫分型的关系[D]. 长春:吉林大学, 2016.
[11] 李乾兵, 陈俊, 徐裕丰,等. COPD患者T淋巴细胞亚群比例及其与BODE指数和急性加重风险的相关性[J]. 皖南医学院学报, 2017, 36(3):224-7.
[12] 刘雪青. 树突状细胞与慢性阻塞性肺疾病关系的探讨[D]. 济宁:济宁医学院, 2015.
[13] 刘雪青, 姜鲁宁, 宋敏. 树突状细胞对慢性阻塞性肺疾病的诊断意义[J]. 中国免疫学杂志, 2015,31(5):678-82.
[14] 黄颖锋,孙广信,周丽娟,等.苏黄止咳胶囊对于慢性阻塞性肺疾病急性加重期患者的临床疗效[J].世界中医药,2017,12(9):2023-7.
[15] Xiong Y, Gao S, Luo G, et al. Increased circulating autoantibodies levels of IgG, IgA, IgM against cytokeratin 18 and cytokeratin 19 in chronic obstructive pulmonary disease[J]. Arch Medl Res, 2017, 48(1):79-87.
[16] 陈昌枝,邵有和,覃家盟,等.慢性阻塞性肺疾病患者免疫球蛋白的表达及与肺功能的关系[J].临床肺科杂志,2015,20(8):1404-6.
[17] 李允, 罗裕文, 郑晶晶,等. 慢性阻塞性肺疾病急性加重期住院患者呼吸道病毒病原学分布及危险因素分析[J]. 中国现代医学杂志, 2016, 26(6):80-4.
[18] 龚峰, 张晓调, 陈显静,等. 慢性阻塞性肺疾病急性加重患者相关病毒感染的危险因素分析[J]. 中华医院感染学杂志, 2017, 27(4):800-3.