Eller J, Ede A, Schaberg T, Niederman M S, Mauch H, Lode H
Department of Infectious Diseases and Immunology, Chest Clinic Heckeshorn, Berlin, Germany.
Chest. 1998 Jun;113(6):1542-8. doi: 10.1378/chest.113.6.1542.
In patients with severe COPD, acute infective exacerbations are frequent. Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacteria in sputum cultures from these patients. We hypothesized that in patients with advanced disease, Gram-negative bacteria other than H influenzae play at least an equally important role.
We evaluated clinical data and sputum culture results from 211 unselected COPD patients admitted to our hospital with an acute infective exacerbation of COPD. One hundred twelve patients fulfilled our protocol criteria of reliable microbiologic results and reproducible lung function tests; the patients were categorized according to the recently published three stages of severity.
Lung function tests revealed an FEV1 of > or =50% of the predicted value in 30 patients (stage I), an FEV1 of 35% to <50% of the predicted value in 30 patients (stage II), and an FEV1 of < or =35% of the predicted value in 34 patients (stage III). Bacteria were classified into three groups: group 1 contained S pneumoniae and other Gram-positive cocci; group 2, H influenzae and Moraxella catarrhalis; and group 3, Enterobacteriaceae and Pseudomonas spp. For all patients together, the most frequently isolated bacteria were group 3 organisms (Enterobacteriaceae and Pseudomonas spp, 48.2%), followed by group 1 organisms (S pneumoniae and other Gram-positive cocci, 30.4%), and group 2 organisms (H influenzae and M catarrhalis, 21.4%). In stage I patients, 14 of 30 had bacteria from group 1, seven of 30 had group 2, and nine of 30 had group 3. In stage II patients, eight of 30 had group 1 bacteria, 10 of 30 had group 2, and 12 of 30 had group 3. In stage III patients, 12 of 52 had group 1 bacteria, seven of 52 had group 2, and 22 of 52 had group 3. The three groups of bacteria causing infective exacerbations were unevenly distributed among the three severity stages of lung function (p=0.016).
There is a correlation between deterioration of lung function and the bacteria isolated from patients with infective exacerbations of COPD. In acute infective exacerbations, Enterobacteriaceae and Pseudomonas spp are the predominant bacteria in patients with an FEV1 < or =35% of the predicted value.
在重度慢性阻塞性肺疾病（COPD）患者中，急性感染性加重很常见。肺炎链球菌和流感嗜血杆菌是这些患者痰培养中最常分离出的细菌。我们推测，在晚期疾病患者中，除流感嗜血杆菌外的革兰氏阴性菌至少起着同样重要的作用。
我们评估了我院收治的211例因COPD急性感染性加重而入院的未经过挑选的COPD患者的临床资料和痰培养结果。112例患者符合我们关于可靠微生物学结果和可重复肺功能测试的方案标准；根据最近公布的三个严重程度阶段对患者进行分类。
肺功能测试显示，30例患者（I期）的第1秒用力呼气容积（FEV1）≥预计值的50%，30例患者（II期）的FEV1为预计值的35%至<50%，34例患者（III期）的FEV1≤预计值的35%。细菌分为三组：第1组包含肺炎链球菌和其他革兰氏阳性球菌；第2组为流感嗜血杆菌和卡他莫拉菌；第3组为肠杆菌科和假单胞菌属。对于所有患者而言，最常分离出的细菌是第3组微生物（肠杆菌科和假单胞菌属，48.2%），其次是第1组微生物（肺炎链球菌和其他革兰氏阳性球菌，30.4%），以及第2组微生物（流感嗜血杆菌和卡他莫拉菌，21.4%）。在I期患者中，30例中有14例的细菌属于第1组，30例中有7例属于第2组，30例中有9例属于第3组。在II期患者中，30例中有8例的细菌属于第1组，30例中有10例属于第2组，30例中有12例属于第3组。在III期患者中，52例中有12例的细菌属于第1组，52例中有7例属于第2组，52例中有22例属于第3组。导致感染性加重的三组细菌在肺功能的三个严重程度阶段中分布不均（p = 0.016）。
肺功能恶化与COPD感染性加重患者分离出的细菌之间存在相关性。在急性感染性加重中，肠杆菌科和假单胞菌属是FEV1≤预计值35%的患者中的主要细菌。
