Sethi S, Muscarella K, Evans N, Klingman K L, Grant B J, Murphy T F
Department of Veterans Affairs Western New York Healthcare System, Buffalo, NY 14215, USA.
Chest. 2000 Dec;118(6):1557-65. doi: 10.1378/chest.118.6.1557.
The etiologic role of bacterial pathogens isolated from sputum culture in 40 to 50% of acute exacerbations of chronic bronchitis (AECB) is controversial. If bacterial pathogens cause these AECB, they should be associated with greater neutrophilic airway inflammation than pathogen-negative exacerbations.
This hypothesis was tested by comparing levels of interleukin (IL)-8, tumor necrosis factor (TNF)-alpha, and neutrophil elastase (NE) in 81 sputum samples obtained from 45 patients with AECB. Four groups were compared. In the first three groups, nontypable Haemophilus influenzae (n = 20), Haemophilus parainfluenzae (n = 27), and Moraxella catarrhalis (n = 14) were isolated as sole pathogens, respectively. In the fourth group, only normal flora was isolated (n = 20). Paired samples, obtained from individual patients at different times, that differed in their culture results were also compared.
An outpatient research clinic at a Veterans Affairs Medical Center.
These patients were participating in a prospective, longitudinal study of the dynamics of bacterial infection in chronic bronchitis, for which they were seen in the study clinic on a monthly basis as well as when they were experiencing symptoms suggestive of AECB.
None.
H influenzae exacerbations were associated with significantly higher sputum IL-8, TNF-alpha, and NE. M catarrhalis exacerbations demonstrated significantly higher sputum TNF-alpha and NE when compared to pathogen-negative exacerbations. H parainfluenzae-associated exacerbations had an inflammatory profile similar to pathogen-negative exacerbations. Sputum elastase level distinguished bacterial from nonbacterial AECB and correlated with clinical severity of the AECB.
Increased airway inflammation associated with isolation of H influenzae and M catarrhalis supports an etiologic role of these pathogens in AECB.
从痰培养中分离出的细菌病原体在40%至50%的慢性支气管炎急性加重（AECB）中所起的病因学作用存在争议。如果细菌病原体导致这些AECB，那么与病原体阴性的加重情况相比，它们应与更严重的中性粒细胞气道炎症相关。
通过比较从45例AECB患者获取的81份痰样本中的白细胞介素（IL）-8、肿瘤坏死因子（TNF）-α和中性粒细胞弹性蛋白酶（NE）水平来验证这一假设。比较了四组。在前三组中，分别分离出不可分型流感嗜血杆菌（n = 20）、副流感嗜血杆菌（n = 27）和卡他莫拉菌（n = 14）作为唯一病原体。在第四组中，仅分离出正常菌群（n = 20）。还比较了从个体患者在不同时间获取的、培养结果不同的配对样本。
一家退伍军人事务医疗中心的门诊研究诊所。
这些患者参与了一项关于慢性支气管炎细菌感染动态的前瞻性纵向研究，为此他们每月在研究诊所就诊，以及在出现提示AECB的症状时就诊。
无。
流感嗜血杆菌加重与痰中IL-8、TNF-α和NE显著升高相关。与病原体阴性的加重情况相比，卡他莫拉菌加重时痰中TNF-α和NE显著升高。副流感嗜血杆菌相关的加重情况具有与病原体阴性加重情况相似的炎症特征。痰弹性蛋白酶水平可区分细菌性与非细菌性AECB，并与AECB的临床严重程度相关。
与流感嗜血杆菌和卡他莫拉菌分离相关的气道炎症增加支持了这些病原体在AECB中的病因学作用。
