Braeken D C W, Franssen F M E, von Baum H, Schütte H, Pletz M W, Rupp J, Stassen F, Mooij M J, Rohde G G U
Department of Research and Education, CIRO, Horn, Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Department of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany.
Int J Tuberc Lung Dis. 2017 Feb 1;21(2):236-243. doi: 10.5588/ijtld.16.0567.
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality, and chronic obstructive pulmonary disease (COPD) is a frequent comorbidity. The bacterial aetiology of CAP-COPD and its possible associations with serum markers and mortality are incompletely understood.
Of 1288 patients with CAP (57.0% males, age 59.0 years ± 18.5), 262 (20.3%) fulfilled the diagnostic criteria for COPD. Differences between subgroups were investigated using univariate analyses and corrected for multiple comparisons.
Streptococcus pneumoniae was the most common pathogen (30.8% CAP only vs. 26.0% CAP-COPD, not significant). Haemophilus influenzae was significantly more frequent in CAP-COPD (5.6% CAP only vs. 26.0% CAP-COPD, P < 0.001). The number given adequate empirical antibiotic treatment was comparable (83.3% CAP only vs. 83.6% CAP-COPD, P > 0.05). The CAP-COPD group had worse CURB-65 and partial pressure of arterial oxygen levels than the CAP only group (P < 0.001). Partial pressure of arterial carbon dioxide levels were increased in CAP-COPD patients without pathogen detection (P < 0.001). Short- (P = 0.011) and long-term mortality (P = 0.006) were highest in CAP-COPD without pathogen detection.
It is important to identify COPD patients with CAP. In particular, those without bacterial pathogen detection have more severe CAP and are at higher risk of dying. Better understanding of the aetiology could contribute to improved management and treatment of CAP in COPD patients.
社区获得性肺炎（CAP）是发病和死亡的主要原因，慢性阻塞性肺疾病（COPD）是常见的合并症。CAP-COPD的细菌病因及其与血清标志物和死亡率的可能关联尚未完全明确。
1）评估单纯CAP和CAP-COPD的细菌病因，2）研究细菌病因、经验性抗生素治疗、血清标志物与死亡率之间的关联。
在1288例CAP患者中（男性占57.0%，年龄59.0岁±18.5岁），262例（20.3%）符合COPD诊断标准。采用单因素分析研究亚组间差异，并对多重比较进行校正。
肺炎链球菌是最常见的病原体（单纯CAP为30.8%，CAP-COPD为26.0%，无显著差异）。流感嗜血杆菌在CAP-COPD中更为常见（单纯CAP为5.6%，CAP-COPD为26.0%，P<0.001）。接受适当经验性抗生素治疗的人数相当（单纯CAP为83.3%，CAP-COPD为83.6%，P>0.05）。CAP-COPD组的CURB-65和动脉血氧分压水平比单纯CAP组更差（P<0.001）。未检测到病原体的CAP-COPD患者动脉血二氧化碳分压水平升高（P<0.001）。未检测到病原体的CAP-COPD患者短期（P=0.011）和长期死亡率（P=0.006）最高。
识别合并COPD的CAP患者很重要。特别是那些未检测到细菌病原体的患者，其CAP更为严重，死亡风险更高。更好地了解病因有助于改善COPD患者CAP的管理和治疗。
