细菌定植与慢性阻塞性肺疾病（COPD）急性加重的频率、特征及严重程度之间的关系。
Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations.
作者信息
Patel I S, Seemungal T A R, Wilks M, Lloyd-Owen S J, Donaldson G C, Wedzicha J A
机构信息
Academic Respiratory Medicine, St Bartholomew's and Royal London School of Medicine and Dentistry, London EC1A 7BE, UK.
出版信息
Thorax. 2002 Sep;57(9):759-64. doi: 10.1136/thorax.57.9.759.
BACKGROUND
Patients with chronic obstructive pulmonary disease (COPD) are prone to frequent exacerbations which are a significant cause of morbidity and mortality. Stable COPD patients often have lower airway bacterial colonisation which may be an important stimulus to airway inflammation and thereby modulate exacerbation frequency.
METHODS
Twenty nine patients with COPD (21 men, 16 current smokers) of mean (SD) age 65.9 (7.84) years, forced expiratory volume in 1 second (FEV(1)) 1.06 (0.41) l, FEV(1) % predicted 38.7 (15.2)%, FEV(1)/FVC 43.7 (14.1)%, inhaled steroid dosage 1.20 (0.66) mg/day completed daily diary cards for symptoms and peak flow over 18 months. Exacerbation frequency rates were determined from diary card data. Induced sputum was obtained from patients in the stable state, quantitative bacterial culture was performed, and cytokine levels were measured.
RESULTS
Fifteen of the 29 patients (51.7%) were colonised by a possible pathogen: Haemophilus influenzae (53.3%), Streptococcus pneumoniae (33.3%), Haemophilus parainfluenzae (20%), Branhamella catarrhalis (20%), Pseudomonas aeruginosa (20%). The presence of lower airway bacterial colonisation in the stable state was related to exacerbation frequency (p=0.023). Patients colonised by H influenzae in the stable state reported more symptoms and increased sputum purulence at exacerbation than those not colonised. The median (IQR) symptom count at exacerbation in those colonised by H influenzae was 2.00 (2.00-2.65) compared with 2.00 (1.00-2.00) in those not colonised (p=0.03). The occurrence of increased sputum purulence at exacerbation per patient was 0.92 (0.56-1.00) in those colonised with H influenzae and 0.33 (0.00-0.60) in those not colonised (p=0.02). Sputum interleukin (IL)-8 levels correlated with the total bacterial count (rho=0.459, p=0.02).
CONCLUSION
Lower airway bacterial colonisation in the stable state modulates the character and frequency of COPD exacerbations.
背景
慢性阻塞性肺疾病（COPD）患者易于频繁急性加重，这是发病和死亡的重要原因。稳定期COPD患者常有下气道细菌定植，这可能是气道炎症的重要刺激因素，进而调节急性加重的频率。
方法
29例COPD患者（21例男性，16例当前吸烟者），平均（标准差）年龄65.9（7.84）岁，第1秒用力呼气容积（FEV₁）1.06（0.41）升，FEV₁占预计值百分比38.7（15.2）%，FEV₁/FVC 43.7（14.1）%，吸入糖皮质激素剂量1.20（0.66）毫克/天，完成了18个月的症状和峰流速每日记录卡。根据记录卡数据确定急性加重频率。从稳定期患者获取诱导痰，进行定量细菌培养并检测细胞因子水平。
结果
29例患者中有15例（51.7%）被可能的病原体定植：流感嗜血杆菌（53.3%）、肺炎链球菌（33.3%）、副流感嗜血杆菌（20%）、卡他莫拉菌（20%）、铜绿假单胞菌（20%）。稳定期下气道细菌定植与急性加重频率相关（p = 0.023）。稳定期被流感嗜血杆菌定植的患者在急性加重时报告的症状更多，痰液脓性增加。流感嗜血杆菌定植患者急性加重时症状计数中位数（四分位间距）为2.00（2.00 - 2.65），未定植患者为2.00（1.00 - 2.00）（p = 0.03）。流感嗜血杆菌定植患者急性加重时痰液脓性增加的发生率为0.92（0.56 - 1.00），未定植患者为0.33（0.00 - 0.60）（p = 0.02）。痰液白细胞介素（IL）-8水平与细菌总数相关（rho = 0.459，p = 0.02）。
结论
稳定期下气道细菌定植调节COPD急性加重的特征和频率。
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