慢性阻塞性肺疾病住院患者呼吸道病原菌构成特点及其影响因素分析

doi:10.19983/j.issn.2096-8493.20220001

摘要/Abstract

摘要：

目的:探讨慢性阻塞性肺疾病(简称“慢阻肺”)住院患者的呼吸道病原菌构成特点,并分析其影响因素。方法:收集中南大学湘雅二医院呼吸与危重症医学科2016年1月至2019年12月收治的1251例住院慢阻肺并进行痰培养检查患者的临床特征和实验室检查,总结病原菌构成特点,比较痰菌阳性组和痰菌阴性组患者临床特征,分析痰检阳性的危险因素。结果:共送检标本1353份,阳性检出率为35.33%(478/1353)。检出的病原菌以革兰阴性菌(52.51%,251/478)及真菌(43.72%,209/478)为主,其中检出率最高的5种革兰阴性菌分别是鲍曼不动杆菌54株(21.51%)、肺炎克雷伯菌53株(21.12%)、铜绿假单胞菌48株(19.12%)、嗜麦芽窄食单胞菌36株(14.34%)、流感嗜血杆菌14株(5.58%);真菌为念珠菌128株(61.24%)、曲霉菌81株(38.76%)。单因素分析结果显示,慢阻肺患者检出病原菌与年龄、既往1年有无急性加重史、入院前是否使用糖皮质激素、体质量指数(BMI)、慢阻肺评估试验(CAT)、改良英国医学研究学会呼吸困难指数(mMRC)、1秒钟用力呼气容积预计值百分比(FEV₁%pre)有关;多因素分析结果显示BMI异常(OR=3.158, 95%CI=1.503~6.634)是检出病原菌的独立危险因素。结论:慢阻肺住院患者易合并革兰阴性菌和真菌感染,对于BMI异常的患者应积极完善病原学检查。

关键词: 肺疾病,慢性阻塞性, 革兰阳性菌, 革兰阴性菌, 真菌, 危险因素

Abstract:

Objective: To investigate the characteristics of the composition of respiratory pathogens in patients hospitalized with chronic obstructive pulmonary disease (COPD) and to analyze the influencing factors. Methods: The clinical characteristics and laboratory test results of 1251 patients admitted to the Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, from January 2016 to December 2019 who were hospitalized with COPD and underwent sputum culture examination were collected to summarize the characteristics of the composition of pathogenic bacteria and to compare the differences in clinical characteristics between the sputum-positive and sputum-negative groups of patients,to analyze the risk factors of sputum positive. Results: There were 1353 specimens sent for examination, and the positive detection rate was 35.33% (478/1353). The detected pathogens were mainly Gram-negative bacteria (52.51%, 251/478) and fungi (43.72%, 209/478), among which the five Gram-negative bacteria with the highest detection rate were Acinetobacter baumannii (21.51%, 54/251), Klebsiella pneumoniae (21.12%, 53/251), Pseudomonas aeruginosa (19.12%, 48/251), Acinetobacter maltophilia (14.34%, 36/251), and Haemophilus influenzae (5.58%, 14/251); the fungi were 128 strains of Candida (61.24%) and 81 strains of Aspergillus (38.76%). Univariate analysis showed that detection of pathogenic bacteria in COPD patients was associated with age, history of acute exacerbation in previous 1-year, pre-admission hormone use, BMI (body mass index), CAT (COPD assessment test), mMRC (modified British medical research council) and FEV₁%pre (expected value of expiratory volume in 1 second with force). Multifactorial analysis showed that abnormal BMI was an independent risk factor for the detection of pathogenic bacteria (OR=3.158, 95%CI=1.503-6.634). Conclusion: Patients hospitalized with COPD were prone to getting combined Gram-negative bacterial infections. For patients with abnormal BMI, pathogenic investigations should be taken proactively.

Key words: Pulmonary disease,chronic obstructive, Gram-positive bacteria, Gram-negative bacteria, Fungi, Risk factors

中图分类号:

R563.3

冼少静, 陈燕, 马义铭, 罗丽娟, 龙颖姣. 慢性阻塞性肺疾病住院患者呼吸道病原菌构成特点及其影响因素分析[J]. 结核与肺部疾病杂志, 2022, 3(3): 209-215. doi: 10.19983/j.issn.2096-8493.20220001

XIAN Shao-jing, CHEN Yan, MA Yi-ming, LUO Li-juan, LONG Ying-jiao. Analysis of the characteristics of the composition of respiratory pathogens and its influencing factors in patients hospitalized with chronic obstructive pulmonary disease[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(3): 209-215. doi: 10.19983/j.issn.2096-8493.20220001

图/表 5

表1

痰菌阳性和痰菌阴性组患者基本特征

项目	痰菌阳性组(371例)	痰菌阴性组(880例)	统计检验值	P值
男性[例,构成比(%)]	333(89.76)	780(88.64)	χ²=0.331	0.622
>65岁[例,构成比(%)]	282(76.01)	560(71.79)	χ²=18.161	<0.001
病程[年,M(Q₁,Q₃)]	10(8,20)	10(6,20)	Z=-0.810	<0.001
吸烟指数 [支/年,M(Q₁,Q₃)]	800(400,1000)	800(320,1060)	Z=-0.235	0.819
BMI( $x ¯$ ±s)	21.05±3.71	20.45±1.90	t=5.267	<0.001
CAT评分( $x ¯$ ±s)	21.33±7.55	18.24±7.69	t=10.302	<0.001
ALB(g/L, $x ¯$ ±s)	32.37±4.60	33.73±4.33	t=7.731	<0.001
FEV₁%pre[%,M(Q₁,Q₃)]	29.00(22.00,40.20)	34.20(24.85,47.05)	Z=6.950	<0.001
住院时间 [d,M(Q₁,Q₃)]	12(9,15)	10(8,12)	Z=-6.971	<0.001

表1

表2

表3

表4

表5

病原菌检出多因素logistic回归分析

因素	β值	s $x ¯$ 值	Wald χ²值	P值	OR(95%CI)值
年龄>65岁	-0.192	0.352	0.298	0.585	0.825(0.414~1.646)
FEV₁%pre<50%	0.057	0.521	0.012	0.912	1.059(0.381~2.942)
BMI异常	1.150	0.379	9.218	0.002	3.158(1.503~6.634)
CAT评分≥10分	0.435	0.622	0.489	0.484	1.545(0.457~5.227)
mMRC分级≥2级	0.253	0.519	0.238	0.625	1.289(0.466~3.566)
既往1年有急性加重	0.125	0.325	0.150	0.744	1.009(0.620~2.112)
入院前曾使用糖皮质激素	0.478	0.799	0.501	0.389	0.975(0.359~1.952)
常量	-4.560	5.006	0.830	0.362	0.010

表5

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项目		痰菌阳性例数		痰菌阴性例数		阳性检出率(%)	统计检验值		P值
BMI分组							χ²=126.040		<0.001
低体质量 (≤18.4)		64		77		45.39
正常 (18.5~23.9)		154		672		18.64
超体质量(24.0~17.9)		44		32		57.89
肥胖(≥28)		14		1		93.33
CAT得分(分级)							χ²=26.980		<0.001
0~10(1级)		22		105		17.32
11~20(2级)		74		283		20.73
21~30(3级)		99		184		34.98
31~40(4级)		30		50		37.50
mMRC分级							χ²=25.800		<0.001
0级		9		28		24.32
1级		37		126		22.70
2级		64		192		25.00
3级		74		203		26.71
4级		103		143		41.87
综合评估分组							χ²=9.460	0.024
A组	10		30		25.00
B组	45		142		24.10
C组	15		58		20.50
D组	266		548		32.70
GOLD分级							χ²=12.340	0.006
1级	3		15		16.70
2级	31		119		20.70
3级	83		248		25.10
4级	124		245		33.60
EOS分型							χ²=1.340	<0.001
非EOS型(血嗜酸性粒细胞百分比<2%)	279		456		37.96
EOS型(血嗜酸性粒细胞百分比≥2%)	90		389		18.79

因素	痰菌阳性例数		痰菌阴性例数		OR值		P值
性別					1.123		0.563
女性	38		100
男性	333		780
年龄组(岁)					1.811		<0.001
≤65	89		320
>65	282		560
入院前使用糖皮质激素					0.543		0.047
否	6		12
是	236		414
既往1年急性加重					1.691		0.002
无	52		174
有	294		582
近3个月使用抗生素					1.278		0.104
否	92		174
是	275		407
吸烟状态					1.273		0.181
否	48		141
是	312		720
BMI分组						2.183		<0.001
正常		154		672
异常		122		110
CAT评分						1.377		0.004
<10		22		105
≥10		203		472
mMRC分级						1.410		0.028
<2		46		154
≥2		241		536
FEV₁%pred						1.248		0.015
≥50%		31		119
<50%		195		411

因素	赋值	因素	赋值
年龄	≤65岁=0;>65岁=1	mMRC分级	<2级(0、1级)=1;≥2级(2、3、4级)=2
FEV₁%pre	<50%=1;≥50%=2	mMRC分级	<2级(0、1级)=1;≥2级(2、3、4级)=2
FEV₁%pre	<50%=1;≥50%=2	既往1年急性加重史	否=0;有=1
BMI	正常组(2组)=0;异常组(1、3、4组)=1	既往1年急性加重史	否=0;有=1
BMI	正常组(2组)=0;异常组(1、3、4组)=1	入院前使用糖皮质激素	否=0;有=1
CAT评分	<10分=1;≥10分=2	入院前使用糖皮质激素	否=0;有=1