慢性阻塞性肺疾病严重加重期的感染与气道炎症

Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.

作者信息

Papi Alberto, Bellettato Cinzia Maria, Braccioni Fausto, Romagnoli Micaela, Casolari Paolo, Caramori Gaetano, Fabbri Leonardo M, Johnston Sebastian L

机构信息

Research Center on Asthma and COPD, Department of Respiratory Diseases, University of Modena and Reggio Emilia, Via del Pozzo 71, I-41100 Modena, Italy.

出版信息

Am J Respir Crit Care Med. 2006 May 15;173(10):1114-21. doi: 10.1164/rccm.200506-859OC. Epub 2006 Feb 16.

DOI:10.1164/rccm.200506-859OC

PMID:16484677

Abstract

RATIONALE

Severe exacerbations of chronic obstructive pulmonary disease (COPD) are major causes of health care costs mostly related to hospitalization. The role of infections in COPD exacerbations is controversial.

OBJECTIVES

We investigated whether COPD exacerbations requiring hospitalization are associated with viral and/or bacterial infection and evaluated relationships among infection, exacerbation severity, assessed by reduction of FEV1, and specific patterns of airway inflammation.

METHODS

We examined 64 patients with COPD when hospitalized for exacerbations, and when in stable convalescence. We measured lung function, blood gases, and exhaled nitric oxide, and examined sputum for inflammation and for viral and bacterial infection.

RESULTS

Exacerbations were associated with impaired lung function (p < 0.01) and increased sputum neutrophilia (p < 0.001). Viral and/or bacterial infection was detected in 78% of exacerbations: viruses in 48.4% (6.2% when stable, p < 0.001) and bacteria in 54.7% (37.5% when stable, p = 0.08). Patients with infectious exacerbations (29.7% bacterial, 23.4% viral, 25% viral/bacterial coinfection) had longer hospitalizations (p < 0.02) and greater impairment of several measures of lung function (all p < 0.05) than those with noninfectious exacerbations. Patients with exacerbations with coinfection had more marked lung function impairment (p < 0.02) and longer hospitalizations (p = 0.001). Sputum neutrophils were increased in all exacerbations (p < 0.001) and were related to their severity (p < 0.001), independently of the association with viral or bacterial infections; sputum eosinophils were increased during (p < 0.001) virus-associated exacerbations.

CONCLUSIONS

Respiratory infections are associated with the majority of COPD exacerbations and their severity, especially those with viral/bacterial coinfection. Airway neutrophilia is related to exacerbation severity regardless of viral and/or bacterial infections. Eosinophilia is a good predictor of viral exacerbations.

摘要

原理

慢性阻塞性肺疾病（COPD）的严重急性加重是医疗费用的主要原因，大多与住院治疗有关。感染在COPD急性加重中的作用存在争议。

目的

我们调查了需要住院治疗的COPD急性加重是否与病毒和/或细菌感染相关，并评估了感染、通过第一秒用力呼气容积（FEV1）降低评估的急性加重严重程度以及气道炎症的特定模式之间的关系。

方法

我们检查了64例因急性加重住院的COPD患者以及处于稳定恢复期的患者。我们测量了肺功能、血气和呼出一氧化氮，并检查痰液中的炎症以及病毒和细菌感染情况。

结果

急性加重与肺功能受损（p < 0.01）和痰液中性粒细胞增多有关（p < 0.001）。在78%的急性加重病例中检测到病毒和/或细菌感染：病毒感染占48.4%（稳定期为6.2%，p < 0.001），细菌感染占54.7%（稳定期为37.5%，p = 0.08）。与非感染性急性加重患者相比，感染性急性加重患者（29.7%为细菌感染，23.4%为病毒感染，25%为病毒/细菌混合感染）住院时间更长（p < 0.02），多项肺功能指标受损更严重（均p < 0.05）。混合感染的急性加重患者肺功能受损更明显（p < 0.02），住院时间更长（p = 0.001）。所有急性加重患者的痰液中性粒细胞均增多（p < 0.001），且与急性加重严重程度相关（p < 0.001），与病毒或细菌感染无关；病毒相关急性加重期间痰液嗜酸性粒细胞增多（p < 0.001）。