慢性阻塞性肺病患者肺炎衣原体感染临床分析

目的 调查慢性肺炎衣原体（Cpn）感染和慢性阻塞性肺病（COPD）之间可能的相关性.方法 选取来我院就诊的COPD急性加重期患者60例,COPD稳定期患者40例,以及同期来院参加健康体检的老年人50例（对照组）,测定其第一秒用力呼气容积（FEV1）、用力肺活量（FVC）和圣乔治呼吸问卷（SGRQ）评分.用ELISA法检测Cpn抗体（IgA,IgG和IgM）.结果 COPD急性加重期患者的Cpn-IgM抗体检出率显著高于对照组（P＜0.01）,COPD急性加重期组和COPD稳定期组Cpn-IgA和IgG抗体的检出率均显著高于对照组（P＜0.01）.阿奇霉素治疗后所有COPD患者的临床症状均有显著改善：SGRQ记分和FEV1占预计值％显著增加,仅COPD急性加重期患者Cpn-IgM滴度显著下降（P＜0.01）.结论 慢性Cpn感染可能是COPD发展的危险因素.     

COPD急性加重期肺炎衣原体感染的临床分析

目的　了解肺炎衣原体急性感染在 COPD急性加重期患者中的发生率及其临床特点。方法　采用固相酶联免疫吸附试验 EL ISA法测定 96例 COPD急性加重期患者血清肺炎衣原体特异性抗体 Ig G及 Ig M,同时进行痰培养 ,急性肺炎衣原体感染者分别给予阿奇霉素及左氧氟沙星治疗。结果　 COPD患者急性肺炎衣原体感染率 2 5 .0 % ,临床表现较其他 COPD患者无明显特征性 (P>0 .0 5 )。COPD患者痰细菌阳性率 5 8.3%。左氧氟沙星对肺炎衣原体急性感染的 COPD患者疗效良好。结论　 COPD急性加重期患者中肺炎衣原体急性感染率高且混合感染率多见 ,合并肺炎衣原体急性感染的 COPD患者临床表现无明显特征性。对于怀疑合并肺炎衣原体感染的COPD患者 ,新喹诺酮类药物可用作早期经验性治疗的药物。     

慢性阻塞性肺疾病患者肺炎衣原体感染的研究

目的 探讨肺炎衣原体感染与慢性阻塞性肺疾病（COPD）的相关性。方法 选择61例COPD急性加重期患者,35例COPD稳定期患者,26名正常对照者,采用微量免疫荧光法测定血清肺炎衣原体特异性抗体IgA,IgM,IgG,套式聚俣酶链反应检测痰中的肺炎衣原体DNA。结果 COPD急性加重期患者的急性肺炎衣原体的感染率为31．1％,明显高于COPD稳定期和且（P＜0．05）。COPD急性加重期组和稳定期组的慢性肺炎衣原体感染率分别为21．3％和31．4％,明显高于对照组（P均＜0．05）,同时IgA的几何平均滴度在COPD急性加重期中最高（20．5）,COPD稳定期组中次之（10．8）,对照组最低（3．6）,三组间差异有显著性（P＜0．05）。结论 急性肺炎衣原体感染为COPD急性加重的一个重要诊因,慢性肺炎衣原体感染可能参与COPD的发病机制。     

Acute purulent exacerbation of chronic obstructive pulmonary disease and Chlamydia pneumoniae infection.

In order to investigate the role of bacteria, including Mycoplasma pneumoniae and especially Chlamydia pneumoniae in acute purulent exacerbations of chronic obstructive pulmonary disease (COPD), we examined sputum specimens and acute and convalescent sera taken 26 d apart from 49 outpatients experiencing an acute purulent exacerbation of COPD. The sera were tested for antibodies to C. pneumoniae with the microimmunofluorescence test, and for antibodies to M. pneumoniae with the indirect fluorescence antibody test. Routine microbiologic culture of sputum yielded potentially pathogenic microorganisms in 12 of the 49 patients (24%). Three patients (6%) showed serologic evidence of recent M. pneumoniae infection. Seven patients showed high IgG titers of >/= 1:1,024 to C. pneumoniae, and an additional four had a fourfold increase in IgG titer, suggesting reinfection with C. pneumoniae. Sputum from two of these 11 patients also grew Streptococcus pneumoniae, and one grew Moraxella catarrhalis. Patients with and without serologic evidence of current C. pneumoniae infection showed no significant differences in clinical features or pulmonary function. The high incidence of infection with C. pneumoniae (the sole causal agent in 16% of cases, and the causal agent with other agents in 6%) provides insight into the importance of this organism among agents leading to exacerbations of COPD in Turkey.     

Chronic Chlamydia pneumoniae infection is a risk factor for the development of COPD

Smoking is the major risk factor for the development of Chronic Obstructive Pulmonary Disease (COPD), but epidemiological data suggest that other etiological factors may also be involved. Chlamydia pneumoniae (Cpn) is an established cause of acute and chronic upper and lower respiratory tract infections. Data obtained from in vitro and in vivo studies indicate that Cpn infection can be involved in the development of both small airways disease and emphysema, the two major components of COPD. The aim of this study was to investigate the possible association between chronic Cpn infection and COPD. The study population was comprised of 199 consecutive patients who underwent bronchoscopy due to longstanding airway symptoms and for whom spirometry and serum samples for serology were available. Acute and convalescent sera were analysed for specific IgG and IgA Cpn antibodies using microimmunofluorescence. Chronic Cpn infection, defined as persistent elevated titres of IgA > or = 1/64, was present in 85 patients. Chronic infection was associated with smoking and higher age, but no gender difference was observed. Thirty patients had COPD, defined as FEV1/FVC < 70% without any features of asthma. Patients with COPD were older than those without, and there was no association with gender in this group. A statistically significant association, remaining after correction for smoking, was observed between chronic Cpn infection and COPD, and there was a trend for decreasing lung function with increasing antibody titres. The results suggest that chronic Cpn infection may be an independent risk factor for the development of COPD.     

肺炎衣原体感染与慢性阻塞性肺疾病关系的研究

目的　探讨肺炎衣原体感染在慢性阻塞性肺疾病 (COPD)发病中的作用。方法　实验分 2部分 ,(1)动物实验 :雄性Wistar大鼠 4 0只 ,分为A、B、C、D组 ,每组 10只 ,除D组外分别予香烟烟雾吸入和 (或 )经气管滴入肺炎衣原体菌液。 6周后测肺功能 ,行肺部病变病理评分及PCR检测肺部肺炎衣原体感染情况。 (2 )临床研究 :用PCR测COPD患者 (17例 )及健康对照者 (19例 )肺脏肺炎衣原体DNA ,同时测血清肺炎衣原体IgG及IgA抗体。结果　 (1)B组和C组大鼠肺组织肺炎衣原体DNAPCR阳性率分别为 88 9%和 80 0 %。B组大鼠肺组织病理改变主要为炎性细胞浸润及小气道平滑肌增生 ,病理及肺功能改变均较A组显著 ;C组主要病理改变为气道壁炎性细胞浸润及平滑肌增生较明显 ,与D组比较差异有显著性 ,肺功能与D组比较无明显差异。 (2 )COPD患者血清IgG抗体阳性率为 82 4 % ,IgA为 5 8 8% ,均明显高于健康对照者 (P值均 <0 0 5 ) ;PCR检测患者肺组织肺炎衣原体DNA均为阴性。结论　肺炎衣原体感染与COPD无直接关系 ,即单纯肺炎衣原体感染不能引起COPD的发病 ,但它可在吸烟所致病变的基础上加重COPD的病理改变及气流阻塞。     

Pseudomonal infections in patients with COPD: epidemiology and management

COPD is a common disease with increasing prevalence. The chronic course of the disease is characterized by acute exacerbations that cause significant worsening of symptoms. Bacterial infections play a dominant role in approximately half of the episodes of acute exacerbations of COPD. The importance of pseudomonal infection in patients with acute exacerbations of COPD stems from its relatively high prevalence in specific subgroups of these patients, and particularly its unique therapeutic ramifications. The colonization rate of Pseudomonas aeruginosa in patients with COPD in a stable condition is low.A review of a large number of clinical series of unselected outpatients with acute exacerbations of COPD revealed that P. aeruginosa was isolated from the patients' sputum at an average rate of 4%. This rate increased significantly in COPD patients with advanced airflow obstruction, in whom the rate of sputum isolates of P. aeruginosa reached 8-13% of all episodes of acute exacerbations of COPD. However, the great majority of bacteria isolated in these patients were not P. aeruginosa, but the three classic bacteria Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. The subgroup of patients, with acute exacerbations of COPD, with the highest rate of P. aeruginosa infection, which approaches 18% of the episodes, is mechanically ventilated patients. However, even in this subgroup the great majority of bacteria isolated are the above-mentioned three classic pathogens. In light of these epidemiologic data and other important considerations, and in order to achieve optimal antibacterial coverage for the common infectious etiologies, empiric antibacterial therapy should be instituted as follows. Patients with acute exacerbations of COPD with advanced airflow obstruction (FEV(1) <50% of predicted under stable conditions) should receive once daily oral therapy with one of the newer fluoroquinolones, i.e. levofloxacin, moxifloxacin, gatifloxacin, or gemifloxacin for 5-10 days. Patients with severe acute exacerbations of COPD who are receiving mechanical ventilation should receive amikacin in addition to one of the intravenous preparations of the newer fluoroquinolones or monotherapy with cefepime, a carbapenem or piperacillin/tazobactam. In both subgroups it is recommended that sputum cultures be performed before initiation of therapy so that the results can guide further therapy.     

A community-based, time-matched, case-control study of respiratory viruses and exacerbations of COPD

Respiratory viruses are associated with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) in hospitalized patients. However, exacerbations are increasingly managed in the community, where the role of viruses is unclear. In community exacerbations, the causal association between viruses and exacerbation maybe confounded by random fluctuations in the prevalence of circulating respiratory viruses. Therefore, to determine whether viral respiratory tract infections are causally associated with community exacerbations, a time-matched case-control study was performed. Ninety-two subjects (mean age 72 yrs), with moderate to severe COPD, (mean FEV(1) 40% predicted), were enrolled. Nasopharyngeal swabs for viral multiplex polymerase chain reaction and atypical pneumonia serology were obtained at exacerbation onset. Control samples were collected in synchrony, from a randomly selected stable patient drawn from the same cohort. In 99 weeks of surveillance, there were 148 exacerbations. Odds of viral isolation were 11 times higher in cases, than their time-matched controls (34 discordant case-control pairs; in 31 pairs only the case had virus and in three pairs only control). Picornavirus (26), influenza A (3), parainfluenza 1,2,3 (2), respiratory syncytial virus (1), and adenovirus (1) were detected in cases while adenovirus (1) and picornavirus (2) were detected in controls. In patients with moderate or severe COPD the presence of a virus in upper airway secretions is strongly associated with the development of COPD exacerbations. These data support the causative role of viruses in triggering COPD exacerbations in the community.     

病毒感染对慢性阻塞性肺病患者免疫功能的影响

为探讨病毒感染对慢性阻塞性肺病（COPD）患者免疫功能的影响，检测了64例COPD急性发作期患者的呼吸道病毒特异抗体IgG、IgM，自然杀伤细胞活性（NK－A），T淋巴细胞亚群及体液免疫IgA、IgG、IgM。结果显示，COPD急性发作期呼吸道合胞病毒（RSV）、腺病毒（ADV)、柯萨奇病毒（COX）、巨细胞病毒（CMV）特异抗体IgG、IgM的阳性率分别是45％、25％，22％、28％及11％、5％和3％、5％。病毒抗体阳性组NK－A和T淋巴细胞亚群显著低于病毒抗体阴性组，而体液免疫无显著差异。提示病毒感染对COPD患者的细胞免疫有明显抑制作用，可能是COPD反复发作的原因之一。     

Correlation of Chlamydia pneumoniae infection with primary biliary cirrhosis

AIM: To evaluate the association between Chlamydia pneumoniae (Cpn) infection and primary biliary cirrhosis (PBC). METHODS: Cpn IgG and IgM were determined by enzyme-linked immunosorbent assay (ELISA) in 41 well-established PBC patients and two race-matched control groups (post-hepatitis cirrhosis, n = 70; healthy controls, n = 57). RESULTS: The mean level and seroprevalence of Cpn IgG in PBC group and post-hepatitis cirrhosis (PHC) group were significantly higher than those in healthy controls (46.8+/-43.4 RU/mL, 49.5+/-45.2 RU/mL vs 28.3+/-32.7 RU/mL; 68.3%, 71.4%, 42.1%, respectively; P<0.05). There was a remarkably elevated seroprevalence of Cpn IgM in patients with PBC (22.0%) compared to the PHC and healthy control (HC) groups. For the PBC patients versus the HCs, the odds ratios (ORs) of the presence of Cpn IgG and IgM were 2.7 (95% CI 0.9-6.1) and 5.1 (95% CI 1.4-18.5), respectively. Though there was no correlation in the level of Cpn IgG with total IgG in sera of patients with PBC (r = -0.857, P = 0.344>0.05), Cpn IgM was related with the abnormally high concentrations of total IgM in PBC group. CONCLUSION: The results of this study do not support the hypothesis that infection with Chlamydia pneumoniae may be a triggering agent or even a causative agent in PBC, but suggest that Chlamydia pneumoniae infection probably contributes to the high level of IgM present in most patients with PBC.     

Systemic and mucosal antibody response to Moraxella catarrhalis after exacerbations of chronic obstructive pulmonary disease

To characterize the immune response to Moraxella catarrhalis after exacerbations of chronic obstructive pulmonary disease (COPD), pre- and postexacerbation serum and sputum supernatant samples obtained during 21 exacerbations in 18 patients were studied, using the homologous infecting isolates. New serum immunoglobulin G (IgG) detected by whole-cell enzyme-linked immunosorbent assay developed after 12 (57.1%) of 21 exacerbations. Analysis of serum samples with flow cytometry, which detects antibodies that are exclusive to epitopes on the bacterial surface, revealed that 5 (23.8%) of the 21 exacerbations were associated with the development of new serum IgG to surface epitopes. Three of these serum samples and 2 other serum samples contained new IgG directed at lipooligosaccharide. Flow cytometry revealed that new mucosal IgA to surface-exposed epitopes of the infecting isolate developed in sputum supernatants after 42% of exacerbations. Therefore, adults with COPD develop variable humoral immune responses to M. catarrhalis after exacerbations, including new serum IgG and new mucosal IgA to epitopes on the bacterial surface.     

Bacterial infections in patients requiring admission for an acute exacerbation of COPD; a 1-year prospective study

STUDY OBJECTIVE: To investigate the frequency of respiratory bacterial infections in hospitalized patients, admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD), to identify the responsible pathogens by sputum culture and to assess patient characteristics in relation to sputum culture results. METHODS: We prospectively evaluated clinical data and sputum culture results of 171 patients, admitted to the pulmonology department of the University Hospital Maastricht with an acute exacerbation of COPD from 1st January 1999 until 31st December 1999. RESULTS: Eighty-five patients (50%) had positive sputum cultures, indicating the presence of bacterial infection. Pathogens most frequently isolated were: Haemophilus influenzae (45%), Streptococcus pneumoniae (27%), and Pseudomonas aeruginosa (15%). Patients with more severely compromised lung function had a higher incidence of bacterial infections (P = 0.026). There were no significant differences in age, lung function parameters, blood gas results and length of hospital stay between patients with and without bacterial infection. There were no correlations between the type of bacteria isolated and clinical characteristics. CONCLUSION: Incidence of bacterial infection during acute exacerbations of COPD is about 50%. Patients with and without bacterial infection are not different in clinical characteristics or in outcome parameters. Patients with lower FEV1 have a higher incidence of bacterial infections, but there is no difference in the type of bacterial infection. In the future, the pathogenic role of bacterial infection in exacerbations of COPD should be further investigated, especially the role of bacterial infection in relation to local and systemic inflammation.     

Pseudomonal Infections in Patients with COPD

COPD is a common disease with increasing prevalence. The chronic course of the disease is characterized by acute exacerbations that cause significant worsening of symptoms. Bacterial infections play a dominant role in approximately half of the episodes of acute exacerbations of COPD. The importance of pseudomonal infection in patients with acute exacerbations of COPD stems from its relatively high prevalence in specific subgroups of these patients, and particularly its unique therapeutic ramifications. The colonization rate of Pseudomonas aeruginosa in patients with COPD in a stable condition is low.A review of a large number of clinical series of unselected outpatients with acute exacerbations of COPD revealed that P. aeruginosa was isolated from the patients’ sputum at an average rate of 4%. This rate increased significantly in COPD patients with advanced airflow obstruction, in whom the rate of sputum isolates of P. aeruginosa reached 8–13% of all episodes of acute exacerbations of COPD. However, the great majority of bacteria isolated in these patients were not P. aeruginosa, but the three classic bacteria Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. The subgroup of patients, with acute exacerbations of COPD, with the highest rate of P. aeruginosa infection, which approaches 18% of the episodes, is mechanically ventilated patients. However, even in this subgroup the great majority of bacteria isolated are the above-mentioned three classic pathogens.In light of these epidemiologic data and other important considerations, and in order to achieve optimal antibacterial coverage for the common infectious etiologies, empiric antibacterial therapy should be instituted as follows. Patients with acute exacerbations of COPD with advanced airflow obstruction (FEV₁ <50% of predicted under stable conditions) should receive once daily oral therapy with one of the newer fluoroquinolones, i.e. levofloxacin, moxifloxacin, gatifloxacin, or gemifloxacin for 5–10 days. Patients with severe acute exacerbations of COPD who are receiving mechanical ventilation should receive amikacin in addition to one of the intravenous preparations of the newer fluoroquinolones or monotherapy with cefepime, a carbapenem or piperacillin/tazobactam. In both subgroups it is recommended that sputum cultures be performed before initiation of therapy so that the results can guide further therapy.     

Acute exacerbation of idiopathic pulmonary fibrosis: role of Chlamydophila pneumoniae infection

BACKGROUND AND OBJECTIVES: Patients with idiopathic pulmonary fibrosis (IPF) may experience acute exacerbations of their illness. The actual trigger(s) of such exacerbations is unknown. Chlamydophila pneumoniae infection can cause exacerbation of asthma and COPD. A prospective study was conducted to investigate the possible role of C. pneumoniae infection in triggering acute exacerbations of IPF. METHODS: A prospective observational study over 5 years of consecutive IPF patients who fulfilled the criteria for acute exacerbation. Sputum, blood cultures and acute and convalescent serology for C. pneumoniae IgG and IgA (ELISA) were performed. RESULTS: Previous infection with C. pneumoniae is common. Of the 27 study patients, 15 had a C. pneumoniae IgG index of 1.10-2.99 (positive) and 3 had a C. pneumoniae IgG index of >2.99 (strongly positive) at the time of presentation with an acute exacerbation. In addition, 15 subjects had a C. pneumoniae IgA index of 1.10-2.99 (positive) and 6 subjects had a C. pneumoniae IgA index of >2.99 (strongly positive). However, only two of the 15 subjects (13%) for whom paired sera were tested exhibited a significant rise in antibody response (change in index of 1.90 for C. pneumoniae IgG and 1.54 for IgA, respectively) indicating either acute or reactivated infection with C. pneumoniae. There were 15 deaths (56%) despite supportive care that included high-dose corticosteroid therapy and oxygen supplementation. CONCLUSIONS: Mortality is high with acute exacerbation of IPF. Acute infection with C. pneumoniae is uncommon at the time of presentation with acute exacerbation of IPF.     

The role of atypical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease.

The aetiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) is heterogeneous and still under discussion. Serological studies have suggested that Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila may play a role in acute exacerbations of COPD. The presence of these atypical pathogens in sputum samples was investigated in patients with stable COPD and with acute exacerbations of COPD using real-time PCR. The present study was part of a randomised, double-blind, single-centre study and a total of 248 sputum samples from 104 COPD patients were included. In total, 122 samples obtained during stable disease (stable-state sputa) and 126 samples obtained during acute exacerbations of COPD (exacerbation sputa) were tested. Of the 122 stable-state sputa, all samples were negative for M. pneumoniae and C. pneumoniae DNA, whereas one sample was positive for Legionella non-pneumophila DNA. Of the 126 exacerbation sputa, all samples were negative for M. pneumoniae and C. pneumoniae DNA, whereas one sample was positive for Legionella non-pneumophila DNA. The possible relationship between the presence of atypical pathogens and the aetiology of acute exacerbations in chronic obstructive pulmonary disease was investigated in patients with stable disease and in those with acute exacerbations using real-time PCR. No indication was found of a role for Legionella spp., Chlamydia pneumoniae or Mycoplasma pneumoniae in stable, moderately severe chronic obstructive pulmonary disease and in its exacerbations.     

Disparate innate immune responses to persistent and acute Chlamydia pneumoniae infection in chronic obstructive pulmonary disease

RATIONALE: Chlamydia pneumoniae (Cpn) infection may play a role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Few data are available comparing persistent and acute infection of this pathogen in the human respiratory tract. OBJECTIVES: To study Cpn-induced innate immune responses in lung tissue from patients with COPD and control subjects ex vivo and in vitro. METHODS: Cpn detection was done by nested polymerase chain reaction, in situ hybridization, and immunohistochemistry ex vivo in unstimulated tissue and in vitro using an acute Cpn infection model. As main endpoints for the assessment of early cellular responses, nuclear factor (NF)-kappaB activation and CXC chemokine ligand (CXCL)-8 expression were evaluated. The role of Toll-like receptors (TLRs) as recognition molecules in Cpn-induced innate responses was tested by blocking experiments. MEASUREMENTS AND MAIN RESULTS: Fifteen percent of patients with COPD were chronically infected with Cpn in contrast to 0% of control subjects (p < 0.05). There were no differences in CXCL-8 and NF-kappaB expression between infected and noninfected COPD tissue ex vivo. In contrast, acute in vitro infection induced an intense innate immune response including up-regulation of TLR2. Blocking experiments demonstrated the predominant role of TLR2 in induction of the early immune response, whereas no influence on chlamydial infection rates was observed. CONCLUSIONS: Acute in vitro infection of human lung tissue with Cpn elicited a marked innate response via TLR2, whereas chronic chlamydial infection in patients with COPD was not associated with enhanced cellular activation. These findings suggest different roles of Cpn during acute and chronic stages of pulmonary infection.     

Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response

RATIONALE: Moraxella catarrhalis is frequently present in the sputum of adults with chronic obstructive pulmonary disease (COPD). Little is known about the role of M. catarrhalis in this common disease. OBJECTIVE: To elucidate the burden of disease, the dynamics of carriage, and immune responses to M. catarrhalis in COPD. METHODS: Prospective cohort study of 104 adults with COPD in an outpatient clinic at the Buffalo Veterans Affairs Medical Center. MEASUREMENTS: Clinical information, sputum cultures, molecular typing of isolates, and immunoassays to measure antibodies to M. catarrhalis. MAIN RESULTS: Over 81 months, 104 patients made 3,009 clinic visits, 560 during exacerbations. Molecular typing identified 120 episodes of acquisition and clearance of M. catarrhalis in 50 patients; 57 (47.5%) of the acquisitions were associated with clinical exacerbations. No instances of simultaneous acquisition of a new strain of another pathogen were observed. The duration of carriage of M. catarrhalis was shorter with exacerbations compared with asymptomatic colonization (median, 31.0 vs. 40.4 days; p = 0.01). Reacquisition of the same strain was rare. The intensity of the serum IgG response was greater after exacerbations than asymptomatic colonization (p = 0.009). Asymptomatic colonization was associated with a greater frequency of a sputum IgA response than exacerbation (p = 0.009). CONCLUSIONS: M. catarrhalis likely causes approximately 10% of exacerbations of COPD, accounting for approximately 2 to 4 million episodes annually. The organism is cleared efficiently after a short duration of carriage. Patients develop strain-specific protection after clearance of M. catarrhalis from the respiratory tract.     

慢性阻塞性肺疾病患者幽门螺杆菌感染的研究

目的探讨幽门螺杆菌（helicobacter pylori,Hp）感染与COPD的关系及在其发病机制中的作用。方法对52例COPD急性加重期患者（急性加重期组）,35例稳定期患者（稳定期组）和22名正常对照者（正常对照组）进行肺功能测定、尿素13C呼气试验检测及血常规、C反应蛋白（CRP）的检测。结果COPD急性发作期组、稳定期组和正常对照组Hp阳性率分别为51．9％、45．1％和18．1％。急性加重期组与稳定期组Hp阳性率差异无统计学意义（P〉0．05）,但与正常对照组比较,差异有统计学意义（P〈0．01）。COPD急性发作期组Hp阳性患者的FEV1％pred和FEV1／FVC水平明显低于阴性组,白细胞水平、CRP均明显高于阴性组患者,差异有统计学意义（P〈0．05）。结论Hp感染与COPD的发病存在相关性,是COPD潜在的致病因素。     

非典型病原菌致成人社区获得性肺炎患者的临床特点分析

目的 研究非典型病原菌感染在成人住院社区获得性肺炎中的重要地位,并对其临床特点进行分析.方法 收集2005年5月至2008年5月来自国内多中心的153例成人社区获得性肺炎住院患者急性期及恢复期双份血清和急性期痰标本,采用间接免疫荧光法检测肺炎衣原体IgG抗体及嗜肺军团菌IgG、IgA及IgM混合抗体滴度,采用被动凝集法检测肺炎支原体IgG、IgA及IgM混合抗体滴度,同时对153份急性期痰标本进行普通细菌培养.用回顾性分析方法了解非典型病原菌在成人社区获得性肺炎住院患者中的地位.结果 153例血清学检测结果中符合非典型病原菌致社区获得性肺炎诊断标准的52例(34.0%),其中47例为单一非典型病原菌感染,其中肺炎衣原体38例,肺炎支原体4例,嗜肺军团菌5例;5例为2种非典型病原菌混合感染,其中肺炎衣原体+肺炎支原体2例,肺炎衣原体+嗜肺军团菌3例;52例中合并细菌感染者11例.结论 非典型病原菌(肺炎衣原体、肺炎支原体及嗜肺军团菌)为成人住院社区获得性肺炎的重要致病菌,以肺炎衣原体为主,同时不能忽视合并细菌感染情况的存在.     

Resource Use Study In COPD (RUSIC): A prospective study to quantify the effects of COPD exacerbations on health care resource use among COPD patients

BACKGROUND:

There is increasing interest in health care resource use (HRU) in Canada, particularly in resources associated with acute exacerbations of chronic obstructive pulmonary disease (COPD).

OBJECTIVE:

To identify HRU due to exacerbations of COPD.

METHODS:

A 52-week, multicentre, prospective, observational study of HRU due to exacerbations in patients with moderate to severe COPD was performed. Patients were recruited from primary care physicians and respirologists in urban and rural centres in Canada.

RESULTS:

In total, 524 subjects (59% men) completed the study. Their mean age was 68.2±9.4 years, with a forced expiratory volume in 1 s of 1.01±0.4 L. Patients had significant comorbidities. There were 691 acute exacerbations of COPD, which occurred in 53% of patients: 119 patients (23%) experienced one acute exacerbation, 70 patients (13%) had two acute exacerbations and 89 patients (17%) had three or more acute exacerbations. Seventy-five patients were admitted to hospital, with an average length of stay of 13.2 days. Fourteen of the patients spent time in an intensive care unit (average length of stay 5.6 days). Factors associated with acute exacerbations of COPD included lower forced expiratory volume in 1 s (P<0.001), high number of respiratory medications prescribed (P=0.037), regular use of oral corticosteroids (OCSs) (P=0.008) and presence of depression (P<0.001). Of the 75 patients hospitalized, only 53 received OCSs, four received referral for rehabilitation and 15 were referred for home care.

CONCLUSIONS:

The present study showed a high prevalence of COPD exacerbations, which likely impacted on HRU. There was evidence of a lack of appropriate management of exacerbations, especially with respect to use of OCSs, and referral for pulmonary rehabilitation and home care.