慢性阻塞性肺疾病急性加重期患者肺部感染的病原菌及危险因素分析

Analysis of pathogens and risk factors of pulmonary infection in patients with acute exacerbation of chronic obstructive pulmonary disease

摘要:

目的 探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者肺部感染病原菌分布、危险因素及相关因子的表达。方法 回顾性分析2016年8月—2020年5月嘉兴市第一医院收治的102例AECOPD患者的临床资料。其中，发生肺部感染者52例作为观察组，未发生肺部感染者50例作为对照组。对AECOPD患者肺部感染病原菌分布特征进行分析，通过单因素及多因素分析AECOPD患者肺部感染危险因素，并对两组患者D二聚体（DD）、纤维蛋白原（FIB）、C反应蛋白（CRP）、降钙素原（PCT）水平进行检测。结果 52例AECOPD肺部感染者中检出病原菌69株。其中革兰阴性菌44株（63.77%），以肺炎克雷伯菌（21.74%）及铜绿假单胞菌（18.84%）为主；革兰阳性菌23株（33.33%），以金黄色葡萄球菌（17.39%）及屎粪肠球菌（8.70%）为主；真菌2株（2.90%）。年龄［R=3.203（95% CI：1.072，9.570）］、糖皮质激素使用时间［R=5.27（95% CI：1.835，15.184）］、住院时间［R=2.925（95% CI：1.077，7.939）］、机械通气史［R=2.964（95% CI：1.006，8.734）］及ABCD分组［R=3.347（95% CI：1.091，10.271）］为AECOPD并发肺部感染的独立危险因素（P <0.05）。观察组DD、FIB、CRP、PCT水平均高于对照组（P <0.05）。结论 AECOPD患者发生肺部感染的致病菌以革兰阴性菌为主，而年龄、糖皮质激素使用时间、住院时间、机械通气史及ABCD分组是患者肺部感染的独立危险因素，且该类患者凝血机制及炎症反应异常。

Abstract:

Objective To investigate the distribution of pathogens, risk factors and expression of related markers in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods The clinical data of 102 patients with AECOPD treated in our hospital from August 2016 to May 2020 were analyzed retrospectively, including 52 patients with pulmonary infection as the observation group and 50 patients without pulmonary infection as the control group. The distribution characteristics of pathogens of pulmonary infection in patients with AECOPD were determined. The univariate and multivariate analyses were performed to explore the risk factors of pulmonary infection in patients with AECOPD, and the levels of D-dimer (DD), fibrinogen (FIB), C-reactive protein (CRP), and procalcitonin (PCT) in the two groups were detected and analyzed.Results Sixty-nine strains of pathogens were detected in the 52 cases of AECOPD with pulmonary infection. Among them, 44 strains of gram-negative bacteria (63.77%) were found, which were mainly Klebsiella pneumoniae (21.74%) and Pseudomonas aeruginosa (18.84%). There were 23 strains of gram-positive bacteria (33.33%), the majority of which were Staphylococcus aureus (17.39%) and Enterococcus faecium (8.70%). Besides, two strains of Fungi were found (2.90%). Age [R = 3.203 (95% CI: 1.072, 9.570)], duration of glucocorticoid use [R = 5.27 (95% CI: 1.835, 15.184)], length of hospital stay [R = 2.925 (95% CI: 1.077, 7.939)], history of mechanical ventilation [R = 2.964 (95% CI: 1.006, 8.734)] and ABCD group [R = 3.347 (95% CI: 1.091, 10.271)] were the influencing factors of AECOPD complicated with pulmonary infection (P < 0.05). The levels of DD, FIB, CRP and PCT in observation group were higher than those in control group (P < 0.05).Conclusions Gram-negative bacteria are the main pathogens of pulmonary infection in patients with AECOPD, while age, glucocorticoid use, hospital stay, history of mechanical ventilation and ABCD group are independent risk factors for the pulmonary infection. In addition, the coagulation and inflammatory reaction are abnormal in this kind of patients, so effective prevention and treatment measures can be taken according to their risk factors to reduce the odds of pulmonary infection.