慢性阻塞性肺疾病急性加重期患者呼吸道病原体IgM抗体检测结果及危险因素分析

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者呼吸道病原体感染情况,并分析其发生的危险因素方法收集368例AECOPD患者的血清标本,采用间接免疫荧光法检测血清中9种呼吸道病原体IgM抗体并比较其阳性率。采用单因素和多因素logistic回归分析评估AECOPD患者呼吸道病原体感染的危险因素结果368例AECOPD患者中呼吸道病原体IgM抗体阳性者130例(35.33%)。272株阳性呼吸道病原体IgM抗体中,甲型流感病毒(IFA)IgM抗体阳性率最高(13.59%),其次为副流感病毒1 ~3型(13.04%)、肺炎支原体(1.41%)。一季度、二季度、三季度、四季度AECOPD患者呼吸道病原体IgM抗体阳性株数分别为99株(36. 40%)、59株(21.69)、80株(29.41%),34株(12. 50%),其中一季度阳性率最高,四季度最低。呼吸道病原体IgM抗体阳性组吸烟、呼吸衰竭、合并糖尿病患者比例及PaO2、1年内急性加重次数均高于阴性组(P<0.05),而两组间其余指标比较差异均无统计学意义(P>0.05):单因素logistic回归分析结果显示,吸烟、PaO2、PaCO2、呼吸衰竭、1年内急性加重次数、季节与AECOPD患者呼吸道病原体感染相关(P<0.05);多因素logistic回归分析结果显示,吸烟、呼吸衰竭、1年内急性加重次数是AECOPD患者呼吸道病原体感染的独立危险因素(P <0.05)结论 AECOPD患者存在呼吸道病原体感染,IFA是主要病原体,吸烟、呼吸衰竭、1年内急性加重次数是感染的危险因素。

Detection of IgM antibody in respiratory tract pathogens and its risk factors analysis in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the respiratory tract pathogens infection in acute exacerbation stage of chronic obstructive pulmonary disease( AECOPD) and analyze its risk factors. Methods Serum samples of 368 patients with AECOPD were collected and indirect immunofluorescence was used to detect 9 kinds of IgM antibodies in respirator} tract and then to compare their positive rates. Univariate and multivariate logistic regression analysis were used to assess risk factors of respiratory pathogen infection in AECOPD patients. Results Among 368 AECOPD patients, 130(35. 33%) patients with tract pathogens IgM antibodys positive. In 272 positive tract pathogens IgM antibodys ,the positive rate of influenza A virus (IFA) IgM antibody was 13.59%,followed by parainfluenza virus type 1-3(13.04%) and mycoplasma pneumoniae(1.41%). In the first quarter,second quarter,third quarter and fourth quarter,the number of IgM antibody positive strains in respiratory pathogens of AECOPD patients were 99( 36. 40%),59( 21.69%), 80(29. 41 %) and 34( 12. 50%) respectively, the positive rate in the first quarter was highest,and that in the fourth quarter was lowest. Rates of patients with smoking, respiratory failure and diabetes, PaO2 and the number of acute exacerbations within 1 year in respiratory tract pathogen IgM antibody positive group were higher than those in negative group( P < 0. 05 ), but there were no significant differences between the two groups( P > 0. 05 ). Univariate logistic regression analysis showed that smoking, PaO2 , PaCO2, respiratory failure, number of acute exacerbations within 1 year and season were associated with respiratory pathogen infection in AECOPD patients( P < 0. 05 ). Multivariate logistic regression analysis showed that smoking, respiratory failure, number of acute exacerbations within 1 year were independent risk factors of respiratory pathogen infection in AECOPD patients ( P < 0. 05 ). Conclusion There is respirator) tract pathogen infection in AECOPD patients and IFA is the main pathogen. Smoking,respiratory,failure and frequency of acute exacerbation in 1 year are risk factors for infection.