囊性纤维化患者的肺部恶化，细菌培养呈阴性。
Pulmonary exacerbations in cystic fibrosis with negative bacterial cultures.
机构信息
Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045, USA.
出版信息
Pediatr Pulmonol. 2010 Jun;45(6):569-77. doi: 10.1002/ppul.21221.
BACKGROUND
Pulmonary exacerbations are a major cause of morbidity in cystic fibrosis (CF) and likely contribute to lung function decline. Exacerbations are often associated with characteristic airway bacteria [CF related bacteria (CFRB)]. However, some patients do not have CFRB detected by culture during exacerbations.
OBJECTIVES
We sought to determine the proportion of airway cultures negative for CFRB during pulmonary exacerbations, and to characterize patients who were CFRB-negative versus CFRB-positive.
METHODS
We performed a retrospective study of patients with CF admitted for a pulmonary exacerbation. Patients were classified as CFRB-positive or CFRB-negative based on admission airway cultures. Demographics, clinical presentation, lung function, history of chronic Pseudomonas aeruginosa infection and improvement in lung function with treatment were compared between groups.
MAIN RESULTS
There were 672 admissions for exacerbation involving 211 patients over 5 years. Seventeen percent were classified as CFRB-negative. Forty-one percent of bronchoalveolar lavage (BAL), 32% of throat and 10% of sputum samples were CFRB-negative. Among patients capable of expectorating sputum, the CFRB-negative group was younger, less likely to have chronic P. aeruginosa, had higher lung function and body mass index (BMI), and had a lower systemic inflammatory response on admission compared to those with CFRB-positive cultures. The two groups had similar numbers of patients with three or more signs and symptoms of a pulmonary exacerbation (88% vs. 92%). Both groups returned to baseline lung function following treatment.
CONCLUSIONS
A significant number of patients with CF and pulmonary exacerbation did not have typical CFRB detected by culture. Patients without CFRB still had characteristic signs and symptoms of pulmonary exacerbation and responded to treatment. Understanding the causes of illness in these patients may improve the diagnosis and treatment of pulmonary exacerbations in CF.
背景
肺部恶化是囊性纤维化（CF）患者发病的主要原因，可能导致肺功能下降。恶化通常与特征性气道细菌（CF 相关细菌（CFRB））有关。然而，有些患者在恶化期间通过培养未检测到 CFRB。
目的
我们旨在确定 CF 患者在肺部恶化期间气道培养物中 CFRB 阴性的比例，并对 CFRB 阴性与 CFRB 阳性患者进行特征描述。
方法
我们对因肺部恶化而住院的 CF 患者进行了回顾性研究。根据入院气道培养物将患者分为 CFRB 阳性或 CFRB 阴性。比较两组患者的人口统计学特征、临床表现、肺功能、慢性铜绿假单胞菌感染史以及治疗后肺功能改善情况。
主要结果
在 5 年内，有 672 例因恶化而住院，涉及 211 名患者。17%的患者被归类为 CFRB 阴性。支气管肺泡灌洗液（BAL）的 41%、咽喉的 32%和痰液的 10%为 CFRB 阴性。在能够咳出痰液的患者中，CFRB 阴性组年龄较小，更不可能患有慢性铜绿假单胞菌，肺功能和体重指数（BMI）较高，入院时全身炎症反应较低，而 CFRB 阳性培养物的患者则较低。两组中出现 3 种或更多肺部恶化体征和症状的患者数量相似（88% vs. 92%）。两组患者在治疗后均恢复至基线肺功能。
结论
大量 CF 患者和肺部恶化患者未通过培养检测到典型的 CFRB。没有 CFRB 的患者仍具有肺部恶化的特征性体征和症状，并对治疗有反应。了解这些患者的疾病原因可能会改善 CF 肺部恶化的诊断和治疗。
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