慢性阻塞性肺疾病（COPD）的肺炎型与非肺炎型急性加重
Pneumonic vs nonpneumonic acute exacerbations of COPD.
作者信息
Lieberman David, Lieberman Devora, Gelfer Yevgenia, Varshavsky Raiesa, Dvoskin Bella, Leinonen Maija, Friedman Maureen G
机构信息
Pulmonary Unit, Division of Internal Medicine, Soroka University Medical Center, the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel 84101.
出版信息
Chest. 2002 Oct;122(4):1264-70. doi: 10.1378/chest.122.4.1264.
STUDY OBJECTIVE
To describe and compare the background, clinical manifestations, disease course, and infectious etiologies of pneumonic acute exacerbations (PNAE) vs nonpneumonic acute exacerbations (NPAE) of COPD.
DESIGN
A prospective, observational study.
SETTING
A tertiary university medical center in southern Israel.
PATIENTS
Twenty-three hospitalizations for PNAE and 217 hospitalizations for NPAE were included in the study. Paired sera were obtained for each of the hospitalizations and were tested serologically for 12 pathogens. Only a significant change in antibody titers or levels was considered diagnostic.
RESULTS
No significant differences were found between the two groups for any of the parameters related to COPD or comorbidity. The clinical type of the exacerbation was not significantly different between the groups. Compared to NPAE, patients with PNAE had lower PO(2) values at hospital admission (p = 0.004) but higher rates of abrupt onset (p = 0.005), ICU admissions (p = 0.006), invasive mechanical ventilation (p = 0.01), mortality (p = 0.007), and longer hospital stay (p = 0.001). In 22 PNAE hospitalizations (96%) and in 153 NPAE hospitalizations (71%), at least one infectious etiology was identified (p = 0.001). Mixed infection was found in 13 patients with PNAE (59%) and in 59 patients with NPAE (39%; not significant [NS]). Viral etiology was identified in 18 patients with PNAE (78%) compared with 99 patients with NPAE (46%; p = 0.003). Pneumococcal etiology was found in 10 patients with PNAE (43%) and in 38 patients with NPAE (18%; p = 0.006). An atypical etiology was identified in 8 patients with PNAE (35%) and 64 patients with NPAE (30%; NS).
CONCLUSIONS
Community-acquired pneumonia is common among patients hospitalized for an acute exacerbation of COPD and is generally manifested by more severe clinical and laboratory parameters. In PNAE, compared to NPAE, viral and pneumococcal etiologies are more common, but the rate of atypical pathogens is similar. The therapeutic significance of these findings should be investigated further.
研究目的
描述并比较慢性阻塞性肺疾病（COPD）的肺炎型急性加重（PNAE）与非肺炎型急性加重（NPAE）的背景、临床表现、病程及感染病因。
设计
一项前瞻性观察性研究。
地点
以色列南部的一所三级大学医学中心。
患者
本研究纳入了23例因PNAE住院的患者和217例因NPAE住院的患者。为每次住院采集配对血清，并对12种病原体进行血清学检测。仅抗体滴度或水平的显著变化被视为诊断依据。
结果
两组在与COPD或合并症相关的任何参数上均未发现显著差异。两组间急性加重的临床类型无显著差异。与NPAE相比，PNAE患者入院时的PO₂值较低（p = 0.004），但起病急骤率较高（p = 0.005）、入住重症监护病房（ICU）率较高（p = 0.006）、有创机械通气率较高（p = 0.01）、死亡率较高（p = 0.007）且住院时间较长（p = 0.001）。在22例PNAE住院患者（96%）和在153例NPAE住院患者（71%）中，至少确定了一种感染病因（p = 0.001）。13例PNAE患者（59%）和59例NPAE患者（39%；无显著差异[NS]）发现混合感染。18例PNAE患者（78%）与99例NPAE患者（46%；p = 0.003）确定为病毒病因。10例PNAE患者（43%）和而38例NPAE患者（18%；p = 0.006）发现肺炎球菌病因。8例PNAE患者（35%）和64例NPAE患者（30%；无显著差异）确定为非典型病因。
结论
社区获得性肺炎在因COPD急性加重住院的患者中很常见，通常表现为更严重的临床和实验室参数。与NPAE相比，PNAE中病毒和肺炎球菌病因更为常见，但非典型病原体的发生率相似。这些发现的治疗意义应进一步研究。
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