Zalacain R, Sobradillo V, Amilibia J, Barrón J, Achótegui V, Pijoan J I, Llorente J L
Service of Pneumology, Hospital de Cruces, Cruces-Barakaldo, Vizcaya, Spain.
Eur Respir J. 1999 Feb;13(2):343-8. doi: 10.1034/j.1399-3003.1999.13b21.x.
The aim of this prospective observational study was to determine those factors influencing bacterial colonization in patients with stable chronic obstructive pulmonary disease (COPD). Eighty-eight outpatients with stable COPD and 20 patients with normal spirometry and chest radiography (controls) had a fibreoptic bronchoscopy performed with topical aerosol anaesthesia. Bacterial colonization was determined using the protected specimen brush (PSB) with a cut-off > or = 10(3) colony-forming units (CFU x mL(-1)). The influence of age, degree of airflow obstruction, smoking habit, pack-yrs of smoking, and chest radiographic findings on bacterial colonization were assessed by univariate and multivariate analysis. Significant bacterial growth was found in 40% of patients and in none of the controls. Haemophilus influenzae, Streptococcus viridans, S. pneumoniae and Moraxella catarrhalis were the most frequent pathogens. After adjustment for other variables, severe airflow limitation (odds ratio (OR) 5.11, 95% confidence interval (CI) 1.45-17.9) and current smoking (OR 3.17, 95% CI 2.5-8) remained associated with positive bacterial cultures. When only potentially pathogenic micro-organisms were considered, significant bacterial growth was found in 30.7% of patients, with severe airflow obstruction (OR 9.28, 95% CI 2.19-39.3) being the only variable independently associated with positive bacterial cultures. Our results show that stable chronic obstructive pulmonary disease patients have a high prevalence of bacterial colonization of distal airways which is mainly related to the degree of airflow obstruction and cigarette smoking.
这项前瞻性观察性研究的目的是确定影响稳定期慢性阻塞性肺疾病（COPD）患者细菌定植的因素。88例稳定期COPD门诊患者和20例肺功能和胸部X线检查正常的患者（对照组）接受了局部雾化麻醉下的纤维支气管镜检查。使用保护性标本刷（PSB）确定细菌定植，临界值为≥10³菌落形成单位（CFU×mL⁻¹）。通过单因素和多因素分析评估年龄、气流阻塞程度、吸烟习惯、吸烟包年数和胸部X线检查结果对细菌定植的影响。40%的患者发现有显著细菌生长，而对照组无一例出现。流感嗜血杆菌、草绿色链球菌、肺炎链球菌和卡他莫拉菌是最常见的病原体。在对其他变量进行校正后，严重气流受限（比值比（OR）5.11，95%置信区间（CI）1.45 - 17.9）和当前吸烟（OR 3.17，95% CI 2.5 - 8）仍与细菌培养阳性相关。当仅考虑潜在致病微生物时，30.7%的患者发现有显著细菌生长，严重气流受限（OR 9.28，95% CI 2.19 - 39.3）是与细菌培养阳性独立相关的唯一变量。我们的结果表明，稳定期慢性阻塞性肺疾病患者远端气道细菌定植的患病率较高，这主要与气流阻塞程度和吸烟有关。
