Chang Chih-Hao, Tsao Kuo-Chien, Hu Han-Chung, Huang Chung-Chi, Kao Kuo-Chin, Chen Ning-Hung, Yang Cheng-Ta, Tsai Ying-Huang, Hsieh Meng-Jer
Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan.
Department of Laboratory Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan ; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan.
Int J Chron Obstruct Pulmon Dis. 2015 Apr 13;10:767-74. doi: 10.2147/COPD.S76740. eCollection 2015.
Viral and bacterial infections are the most common causes of chronic obstructive pulmonary disease (COPD) exacerbations. Whether serum inflammatory markers can differentiate bacterial from virus infection in patients with COPD exacerbation requiring emergency department (ED) visits remains controversial.
Viral culture and polymerase chain reaction (PCR) were used to identify the viruses in the oropharynx of patients with COPD exacerbations. The bacteria were identified by the semiquantitative culture of the expectorated sputum. The peripheral blood white blood cell (WBC) counts, serum C-reactive protein (CRP), procalcitonin (PCT), and clinical symptoms were compared among patients with different types of infections.
Viruses were isolated from 16 (22.2%) of the 72 patients enrolled. The most commonly identified viruses were parainfluenza type 3, influenza A, and rhinovirus. A total of 30 (41.7%) patients had positive bacterial cultures, with the most commonly found bacteria being Haemophilus influenzae and Haemophilus parainfluenzae. Five patients (6.9%) had both positive sputum cultures and virus identification. The WBC, CRP, and PCT levels of the bacteria-positive and bacteria-negative groups were not statistically different. Multivariate analysis showed that patients with increased sputum volumes during the COPD exacerbations had higher risks of recurrent exacerbations in the 1-year period following the first exacerbation.
WBC, CRP, or PCT could not differentiate between bacterial and viral infections in patients with COPD exacerbation requiring ED visits. Those with increased sputum during a COPD exacerbation had higher risks for recurrent exacerbations.
病毒和细菌感染是慢性阻塞性肺疾病（COPD）急性加重的最常见原因。对于需要到急诊科就诊的COPD急性加重患者，血清炎症标志物能否区分细菌感染和病毒感染仍存在争议。
采用病毒培养和聚合酶链反应（PCR）鉴定COPD急性加重患者口咽部的病毒。通过咳出痰液的半定量培养鉴定细菌。比较不同类型感染患者的外周血白细胞（WBC）计数、血清C反应蛋白（CRP）、降钙素原（PCT）及临床症状。
72例纳入患者中，16例（22.2%）分离出病毒。最常见的病毒为3型副流感病毒、甲型流感病毒和鼻病毒。共有30例（41.7%）患者细菌培养阳性，最常见的细菌为流感嗜血杆菌和副流感嗜血杆菌。5例（6.9%）患者痰液培养和病毒鉴定均为阳性。细菌阳性组和细菌阴性组的WBC、CRP和PCT水平无统计学差异。多因素分析显示，COPD急性加重期间痰液量增加的患者在首次急性加重后1年内再次急性加重的风险更高。
对于需要到急诊科就诊的COPD急性加重患者，WBC、CRP或PCT无法区分细菌感染和病毒感染。COPD急性加重期间痰液增加的患者再次急性加重的风险更高。
