Naito Keisuke, Yamasaki Kei, Yatera Kazuhiro, Akata Kentaro, Noguchi Shingo, Kawanami Toshinori, Fukuda Kazumasa, Kido Takashi, Ishimoto Hiroshi, Mukae Hiroshi
Department of Respiratory Medicine.
Department of Microbiology, University of Occupational and Environmental Health, Japan, Kitakyushu City, Fukuoka.
Int J Chron Obstruct Pulmon Dis. 2017 Jul 20;12:2111-2120. doi: 10.2147/COPD.S140901. eCollection 2017.
Pulmonary emphysema is an important radiological finding in chronic obstructive pulmonary disease patients, but bacteriological differences in pneumonia patients according to the severity of emphysematous changes have not been reported. Therefore, we evaluated the bacteriological incidence in the bronchoalveolar lavage fluid (BALF) of pneumonia patients using cultivation and a culture-independent molecular method. Japanese patients with community-acquired pneumonia (83) and healthcare-associated pneumonia (94) between April 2010 and February 2014 were evaluated. The BALF obtained from pneumonia lesions was evaluated by both cultivation and a molecular method. In the molecular method, ~600 base pairs of bacterial 16S ribosomal RNA genes in the BALF were amplified by polymerase chain reaction, and clone libraries were constructed. The nucleotide sequences of 96 randomly selected colonies were determined, and a homology search was performed to identify the bacterial species. A qualitative radiological evaluation of pulmonary emphysema based on chest computed tomography (CT) images was performed using the Goddard classification. The severity of pulmonary emphysema based on the Goddard classification was none in 47.4% (84/177), mild in 36.2% (64/177), moderate in 10.2% (18/177), and severe in 6.2% (11/177). Using the culture-independent molecular method, was significantly more frequently detected in moderate or severe emphysema patients than in patients with no or mild emphysematous changes. The detection rates of and were unrelated to the severity of pulmonary emphysematous changes, and species - except for the group and - were detected more frequently using the molecular method we used for the BALF of patients with pneumonia than using culture methods. Our findings suggest that is more frequently detected in pneumonia patients with moderate or severe emphysema than in those with no or mild emphysematous changes on chest CT. may play a major role in patients with pneumonia complicating severe pulmonary emphysema.
肺气肿是慢性阻塞性肺疾病患者的一项重要影像学表现，但关于肺炎患者中根据肺气肿变化严重程度的细菌学差异尚未见报道。因此，我们采用培养法和一种非培养分子方法评估了肺炎患者支气管肺泡灌洗液（BALF）中的细菌学发生率。对2010年4月至2014年2月期间的日本社区获得性肺炎患者（83例）和医疗保健相关肺炎患者（94例）进行了评估。从肺炎病灶获取的BALF通过培养法和分子方法进行评估。在分子方法中，通过聚合酶链反应扩增BALF中细菌16S核糖体RNA基因的约600个碱基对，并构建克隆文库。测定96个随机选择菌落的核苷酸序列，并进行同源性搜索以鉴定细菌种类。基于胸部计算机断层扫描（CT）图像，采用戈达德分类法对肺气肿进行定性影像学评估。根据戈达德分类法，肺气肿严重程度为无肺气肿的占47.4%（84/177），轻度肺气肿的占36.2%（64/177），中度肺气肿的占10.2%（18/177），重度肺气肿的占6.2%（11/177）。使用非培养分子方法，在中度或重度肺气肿患者中检测到[具体细菌名称未给出]的频率显著高于无或轻度肺气肿变化的患者。[具体细菌名称未给出]和[具体细菌名称未给出]的检出率与肺气肿变化的严重程度无关，并且除了[具体细菌名称未给出]组和[具体细菌名称未给出]外，使用我们用于肺炎患者BALF的分子方法比培养方法更频繁地检测到[具体细菌名称未给出]种。我们的研究结果表明，与胸部CT上无或轻度肺气肿变化的肺炎患者相比，中度或重度肺气肿的肺炎患者中[具体细菌名称未给出]的检测频率更高。[具体细菌名称未给出]可能在并发严重肺气肿的肺炎患者中起主要作用。
