慢性阻塞性肺疾病稳定期患者戒烟前后下呼吸道定植菌的变化

目的 探讨吸烟对慢性阻塞性肺疾病(COPD)患者下呼吸道细菌定植(LABC)的影响.方法 将确诊为中、重度COPD患者分为持续吸烟的吸烟组、成功戒烟的戒烟组和不吸烟的对照组,在其稳定期进行肺功能检查、下呼吸道诱导痰细菌学检查,比较三组患者2年后LABC变化情况、FEV1值变化情况和年平均急性加重次数.结果 吸烟组及戒烟组在戒烟前的LABC发生率显著高于对照组,戒烟组在戒烟后LABC发生率较戒烟前显著降低(P＜0.05),也比吸烟组同期监测的LABC发生率增高(P＜0.05),两组患者的下呼吸道定植菌均主要为肺炎球菌、流感嗜血杆菌、卡他莫拉菌,对照组及戒烟组在戒烟后下呼吸道定植菌中铜绿假单胞菌比例较吸烟组显著下降(P＜0.05),吸烟组在2年后肺功能FEV1下降差值较对照组显著增大(P＜0.05),吸烟组每年因急性加重住院天数增多(P＜0.05).结论 长期吸烟可导致中重度COPD稳定期患者LABC发生率增高,是影响COPD的病程的重要因素.戒烟在COPD治疗中有积极的意义.

The influence of smoking on lower airway bacterial colonization in stable phase of chronic obstructive pulmonary disease

Objective To observe the influence of smoking on lower airway bacterial colonization（LABC） in stable phase of chronic obstructive pulmonary disease （COPD）. Methods 104 patients with moderate or severe COPD were divided into three groups ：42 cases smoking continuously were divided into A group,36 cases quit smoking were B group,34 non-smoker were C group. Induced sputum were analyzed for quantitiative bacteriology and bacterial culture,pulmonary function was evaluated at begining and In two years later. Results Smokers has higher positive rate of LABC than non-smokers; patients in B group has significantly lower positive rate of bacterial culture in quit smoking 2 years late than before, and significantly lower than that in A group;bacterial colonization in A group and B group include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis; patients in B group quit smoking 2 years late and patients in C group has significantly lower positive rate of P.~eudomonas aeruginosa, significandy decreased exacerbation frequency and decline of FEV1 than patients in A group. Conclusion Smoking increase positive rate of LABC in patients with moderate or severe COPD. Smoking is an important factor in deterioration of lung function in COPD. there is positive significance＇to quit smoking in patients with COPD.