Finney Lydia J, Ritchie Andrew, Pollard Elizabeth, Johnston Sebastian L, Mallia Patrick
Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom.
King's College London, London, United Kingdom.
Int J Chron Obstruct Pulmon Dis. 2014 Oct 13;9:1119-32. doi: 10.2147/COPD.S54477. eCollection 2014.
Bacterial infection of the lower respiratory tract in chronic obstructive pulmonary disease (COPD) patients is common both in stable patients and during acute exacerbations. The most frequent bacteria detected in COPD patients is Haemophilus influenzae, and it appears this organism is uniquely adapted to exploit immune deficiencies associated with COPD and to establish persistent infection in the lower respiratory tract. The presence of bacteria in the lower respiratory tract in stable COPD is termed colonization; however, there is increasing evidence that this is not an innocuous phenomenon but is associated with airway inflammation, increased symptoms, and increased risk for exacerbations. In this review, we discuss host immunity that offers protection against H. influenzae and how disturbance of these mechanisms, combined with pathogen mechanisms of immune evasion, promote persistence of H. influenzae in the lower airways in COPD. In addition, we examine the role of H. influenzae in COPD exacerbations, as well as interactions between H. influenzae and respiratory virus infections, and review the role of treatments and their effect on COPD outcomes. This review focuses predominantly on data derived from human studies but will refer to animal studies where they contribute to understanding the disease in humans.
慢性阻塞性肺疾病（COPD）患者下呼吸道的细菌感染在稳定期患者和急性加重期均很常见。在COPD患者中检测到的最常见细菌是流感嗜血杆菌，这种微生物似乎特别适应利用与COPD相关的免疫缺陷，并在下呼吸道建立持续感染。稳定期COPD患者下呼吸道存在细菌被称为定植；然而，越来越多的证据表明，这并非无害现象，而是与气道炎症、症状加重以及急性加重风险增加有关。在本综述中，我们讨论了针对流感嗜血杆菌的宿主免疫，以及这些机制的紊乱与病原体免疫逃逸机制如何共同促进流感嗜血杆菌在COPD患者下气道的持续存在。此外，我们研究了流感嗜血杆菌在COPD急性加重中的作用，以及流感嗜血杆菌与呼吸道病毒感染之间的相互作用，并综述了治疗的作用及其对COPD预后的影响。本综述主要关注来自人体研究的数据，但也会提及有助于理解人类疾病的动物研究。
