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目的了解慢性阻塞性肺疾病急性加重(AECOPD)患者下呼吸道病原学分布,探讨不同病原体感染对AECOPD患者康复及气道炎症反应的影响。方法收集2008-11-15—2009-03-15河北省10家医院呼吸内科住院3d内的AECOPD患者的痰液,记录相关临床资料。以细菌聚合酶链式反应(PCR)试剂盒和病毒PCR试剂盒对106份合格痰标本进行检测。酶联免疫吸附法(ELISA)测定88份痰液中白介素6(IL-6)和肿瘤坏死因子α(TNF-α)含量。结果病毒阳性率为37.7%,最常见的是甲型流感病毒(16.0%)、鼻病毒(10.4%)。细菌的阳性率为40.6%,最常见的是肺炎链球菌(26.4%)。病毒阳性组平均康复时间31.59d,阴性组14.82d,两组比较差异有统计学意义(P=0.02)。病毒阳性组痰中IL-6含量(114.92±44.82)ng/L高于阴性组(70.74±46.59)ng/L(P<0.001);两组TNF-α含量差异无统计学意义。细菌阳性组与阴性组痰中IL-6、TNF-α含量差异均无统计学意义。多种病毒感染者痰中IL-6含量(122.51±39.86)ng/L高于单一病毒感染(65.30±34.92)ng/L(P=0.005);细菌与病毒混合感染者痰中IL-6含量(120.31±46.62)ng/L高于单一感染(83.61±47.83)ng/L(P=0.02)。结论肺炎链球菌、甲型病毒是AECOPD早期的重要诱因;而病毒感染患者康复时间明显延长;同时痰中IL-6含量显著升高,提示病毒是加重COPD气道炎症反应的重要诱因;甲型流感病毒应受到关注。
Objective To understand the distribution of lower respiratory tract etiology in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and to investigate the effects of different pathogens on the rehabilitation and airway inflammation in AECOPD patients. Methods The sputum of patients with AECOPD within 3 days of hospital residency in 10 hospitals of Hebei Province were collected and the relevant clinical data were recorded during 2008-11-15-2009-03-15. 106 qualified sputum samples were detected by bacterial polymerase chain reaction (PCR) kit and virus PCR kit. The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in 88 sputum samples were determined by enzyme linked immunosorbent assay (ELISA). Results The positive rate of virus was 37.7%. The most common ones were influenza A (16.0%) and rhinovirus (10.4%). The positive rate of bacteria was 40.6%, the most common being Streptococcus pneumoniae (26.4%). The average recovery time of virus positive group was 31.59 days, and that of negative group was 14.82 days. There was significant difference between the two groups (P = 0.02). The level of IL-6 in the sputum positive group (114.92 ± 44.82) ng / L was significantly higher than that in the negative group (70.74 ± 46.59) ng / L (P <0.001). There was no significant difference between the two groups in the level of TNF-α. There were no significant differences in the levels of IL-6 and TNF-α in the sputum between the positive and negative bacteria groups. The levels of IL-6 in sputum from patients with multiple virus infections (122.51 ± 39.86) ng / L were significantly higher than those from single virus infections (65.30 ± 34.92 ng / L, P = 0.005) (120.31 ± 46.62) ng / L was higher than that of single infection (83.61 ± 47.83) ng / L (P = 0.02). Conclusions Streptococcus pneumoniae and A virus are important early AECOPD inducing factors. The recovery time of patients with virus infection is obviously prolonged. Meanwhile, the content of IL-6 in sputum is significantly increased, suggesting that the virus is an important incentive to aggravate airway inflammation in COPD. Influenza virus should receive attention.