a Department of Respiratory Medicine , Gold Coast University Hospital, Gold Coast Health , Southport , Australia.
b Griffith University School of Medicine , Southport , Australia.
Crit Rev Microbiol. 2018 Mar;44(2):125-142. doi: 10.1080/1040841X.2017.1329274. Epub 2017 May 25.
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. In the lower airways of COPD patients, bacterial infection is a common phenomenon and Haemophilus influenzae is the most commonly identified bacteria. Haemophilus influenzae is divided into typeable and nontypeable (NTHi) strains based on the presence or absence of a polysaccharide capsule. While NTHi is a common commensal in the human nasopharynx, it is associated with considerable inflammation when it is present in the lower airways of COPD patients, resulting in morbidity due to worsening symptoms and increased frequency of COPD exacerbations. Treatment of lower airway NTHi infection with antibiotics, though successful in the short term, does not offer long-term protection against reinfection, nor does it change the course of the disease. Hence, there has been much interest in the development of an effective NTHi vaccine. This review will summarize the current literature concerning the role of NTHi infections in COPD patients and the consequences of using prophylactic antibiotics in patients with COPD. There is particular focus on the rationale, findings of clinical studies and possible future directions of NTHi vaccines in patients with COPD.
慢性阻塞性肺疾病（COPD）是全球发病率和死亡率的主要原因。在 COPD 患者的下呼吸道中，细菌感染是一种常见现象，而流感嗜血杆菌是最常被识别的细菌。流感嗜血杆菌根据是否存在多糖荚膜分为可分型和不可分型（NTHi）菌株。虽然 NTHi 是人类鼻咽部的常见共生菌，但当它存在于 COPD 患者的下呼吸道时，会引起相当大的炎症，导致症状恶化和 COPD 加重的频率增加，从而导致发病率增加。用抗生素治疗下呼吸道 NTHi 感染虽然在短期内有效，但不能提供长期的预防再感染的保护，也不能改变疾病的进程。因此，人们对开发有效的 NTHi 疫苗产生了浓厚的兴趣。这篇综述将总结目前关于 NTHi 感染在 COPD 患者中的作用以及在 COPD 患者中使用预防性抗生素的后果的文献。特别关注 NTHi 疫苗在 COPD 患者中的合理性、临床研究结果和可能的未来方向。
