慢性阻塞性肺疾病稳定期下呼吸道细菌定植与肺功能关系研究

目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者下呼吸道细菌定植(lower airway bacterial colonization,LABC)与气道炎症和肺功能损害之间的关系.方法 在稳定期入选确诊中、重度COPD患者(男性38例,中度24例)46例,于基线期进行痰菌落计数、细菌培养,细胞因子检测和肺功能检查,随访1年后统计患者COPD急性加重次数,并于研究结束时复测肺功能.结果 在基线期痰细菌菌落计数＞104 cfu/ml的患者为15例(32.6%),提示存在LABC,以流感嗜血杆菌为主(7/15).存在LABC患者基线期痰液中的白介素6及肿瘤坏死因子α分别为(188.33±127.19)pg/ml和(169.33±119.86)pg/ml]显著高于无LABC患者组分别为(104.84±133.84)pg/ml和(100.97±108.85)pg/ml](P＜0.05);两组1年内急性加重次数分别为(2.92±1.11)次和(2.21±0.49)次,而第1秒用力呼气容积下降值分别为(0.063±0.12)L和(0.044±0.13)L,差异有统计学意义(P＜0.05);肺功能下降水平与急性加重发生次数呈显著正相关(P＜0.05).结论 部分COPD稳定期患者的气道中存在LABC,以流感嗜血杆菌为主,LABC可能是影响COPD病程的重要因素.

Relationship between lower airway bacterial colonization and lung function in patients with chronic obstructive pulmonary disease

Objective To discuss the relationship between lower airway bacterial colonization(LABC), frequency of chronic obstructive pulmonary disease(COPD) exacerbations and lung fuction by case control study. Methods Forty-six patients with moderate or severe COPD(male 38,moderate 24) were included.Sputum samples which collected at recruitment were analyzed for quantitiative bacteriology,bacterial culture and IL-6,IL-8 and TNF-α were measured by ELISA,lung function was evaluated at the beginning and the end of the research. Bacterial count＞106 cfu/ml in sputum was defined as colonization. Results At baseline,fifteen patients were considered colonized by a possible pathogen(32.6%), Haemophilus influenzae was the most important colonized pathogen(7/15);IL-6 and TNF-α in patients' sputum with LABC were significantly higher than those of negative group(188.33±127.19) pg/ml vs (104.84±133. 84) pg/ml and (169. 33± 119.86) pg/ml vs (100.97±108. 85) pg/ml respectively]. Patients with LABC were associated with significantly increased exacerbation frequency, (2.92±1.11) times vs (2.21±0. 49) times and decline of FEV1 ,(0. 063±0. 12 ) L vs (0. 044 ± 0. 13) L. The deterioration of lung function showed a positive correlation with the frequency of exacerbation( P＜0.05). Conclusions Some patients with clinically stable COPD had LABC, LABC may be an important factor in deterioration of lung function in COPD.