切换至 "中华医学电子期刊资源库"
高级检索
中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (01) : 15 -19. doi: 10.3877/cma.j.issn.1674-6902.2023.01.004

论著

病原体检测对慢性阻塞性疾病并发肺炎的诊断价值
蔡丽婷1, 田家伟1, 曹磊1,†(), 刘澄英1   
  1. 1. 214400　江阴，东南大学医学院附属江阴医院呼吸与危重症医学科
  • 收稿日期:2022-11-14 出版日期:2023-02-25
  • 通信作者: 曹磊

Diagnostic significance of pathogen detection in chronic obstructive disease complicated with pneumonia

Liting Cai1, Jiawei Tian1, Lei Cao1,†(), Chengying Liu1   

  1. 1. Department of Respiratory and Critical Care Medicine, Jiangyin Hospital Affiliated to Medical College of Southeast University, Jiangyin 214400, China
  • Received:2022-11-14 Published:2023-02-25
  • Corresponding author: Lei Cao
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

蔡丽婷, 田家伟, 曹磊, 刘澄英. 病原体检测对慢性阻塞性疾病并发肺炎的诊断价值[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 15-19.

Liting Cai, Jiawei Tian, Lei Cao, Chengying Liu. Diagnostic significance of pathogen detection in chronic obstructive disease complicated with pneumonia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(01): 15-19.

目的

分析慢性阻塞性肺疾病并发社区获得性肺炎(chronic obstructive pulmonary disease complicated with community acquired pneumonia, COPD-CAP)患者的临床特征及多种病原体检测对该疾病的诊断价值。

方法

选择2019年1月至2021年1月我院收治的COPD-CAP患者95例为对象，按是否行宏基因测序(metagenome next-generation sequencing, mNGS)病原体检测分为对照组79例，观察组16例。对照组病原体检测采用传统培养，观察组在此基础上采用支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF) mNGS，分析COPD-CAP病原体分布、阳性率及炎症指标情况。

结果

COPD-CAP患者病原体检测结果以革兰氏阴性菌为主，其中肺炎克雷伯杆菌22例(23.16%)、铜绿假单胞菌13例(13.68%)、鲍曼不动杆菌11例(11.58%)、嗜麦芽窄食单胞菌7例(7.37%)、大肠杆菌2例(2.11%)。传统培养(痰液、灌洗液、血液培养)病原体检测阳性率20%，BALF mNGS病原体检测阳性率50%，两者联合病原体检测阳性率26.32% (χ2＝6.638，P＝0.036)。治疗后观察组较对照组WBC(6.63±2.22 vs. 8.68±4.23)×109、PCT(0.18±0.25 vs. 0.63±0.89)ng/ml、CRP(22.35±13.31 vs. 22.57±25.24)mg/L下降(P<0.05)。COPD-CAP患者胸部CT特点，以外周病变59例(74.68%)、磨玻璃影病变+实变影20例(25.32%)、病变面积1/3-2/3有44例(55.70%)为主。治疗后两组CT对比肺炎吸收情况，无统计学差异(χ2＝6.464，P＝0.091)。

结论

多种病原体检测联合应用对COPD-CAP诊断具有临床意义。

关键词: 肺疾病，慢性阻塞性, 肺炎, 宏基因二代测序
Objective

To analyze the clinical features of patients with chronic obstructive pulmonary disease complicated with community acquired pneumonia (COPD-CAP) and the diagnostic significance of multiple pathogen detection for this disease.

Methods

All of 95 patients with COPD-CAP in our hospital between January 2019 and January 2021 were selected as subjects and divided into control group 79 cases and observation group 16 cases according to metagenome next-generation sequencing (mNGS) pathogen detection. Traditional culture was used for pathogen detection in the control group, and bronchoalveolar lavage fluid (BALF) mNGS was used in the observation group to analyze the pathogen distribution, positive rate and inflammatory indicators of COPD-CAP.

Results

The pathogen detection results of patients with COPD-CAP were mainly Gram-negative bacteria, including 22 cases of Klebsiella pneumoniae (23.16%), 13 cases of Pseudomonas aeruginosa (13.68%), 11 cases of Acinetobacter baumannii (11.58%), 7 cases of stenotrophomonas maltophilia (7.37%), and 2 cases of Escherichia coli (2.11%). The positive rate of traditional culture (sputum, lavage, blood culture) was 20%, BALF mNGS was 50%, and the positive rate of combined culture was 26.32% (χ2=6.638, P=0.036). Compared with the control group, WBC (6.63±2.22 vs. 8.68±4.23)×109, PCT (0.18±0.25 vs. 0.63±0.89)ng/ml and CRP (22.35±13.31 vs. 22.57±25.24)mg/L were decreased in the observation group (P<0.05). CT features of chest in patients with COPD-CAP showed that there were 59 cases of peripheral lesions (74.68%), 20 cases of ground glass shadow lesions + solid shadow (25.32%), and 44 cases (55.70%) of lesions with 1/3 to 2/3 area. After treatment, there was no significant difference in the absorption of pneumonia by CT (χ2=6.464, P=0.091).

Conclusion

The combined application of multiple pathogen detection has clinical significance for the diagnosis and treatment of COPD-CAP.

Key words: Chronic obstructive pulmonary disease, Community-acquired pneumonia, Metagenome next-generation sequencing
表1 COPD-CAP患者病原体分布情况
病原菌 例数 构成比(%)
革兰氏阳性菌 10 10.53
肺炎链球菌 1 1.05
金黄色葡萄球菌 6 6.31
溶血性葡萄球菌 3 3.15
革兰氏阴性菌 55 57.89
肺炎克雷伯杆菌 22 23.16
铜绿假单胞菌 13 13.68
鲍曼不动杆菌 11 11.58
嗜麦芽窄食单胞菌 7 7.37
流感嗜血杆菌 0  
大肠杆菌 2 2.11
非典型病原体 10 10.53
肺炎支原体 10 10.53
鹦鹉热衣原体 0  
病毒 4 4.21
疱疹病毒 3 3.15
细环病毒 1 1.05
结核分支杆菌 2 2.11
烟曲霉 1 1.05
其他 3 3.15
表2 COPD-CAP患者入院前胸部CT影像学特点
CT影像 变　量 例数 构成比(%)
病变部位 肺门 20 25.32
  肺部外周 59 74.68
特征 全磨玻璃影 8 1.13
  磨玻璃影+局部实变 20 25.32
  全实变影 51 64.56
病变面积 <1/3 10 12.66
  1/3~2/3 44 55.70
  >2/3 25 31.65
表3 两组治疗前后炎症指标比较(±s)
组　别 例数 治疗前后 WBC(×109) PCT(ng/ml) CRP(mg/L)
观察组 79 治疗前 10.70±4.56 0.72±1.02 77.61±54.99
    治疗后 6.63±2.22 0.18±0.25 22.35±13.31
F值     27.343 43.613 9.829
对照组 16 治疗前 11.04±6.89 1.86±3.36 43.85±60.69
    治疗后 8.68±4.23 0.63±0.89 22.57±25.24
F值     13.524 22.153 18.558
表4 两组治疗后胸部CT吸收情况[n(%)]
组　别 例数 未吸收 <1/3 1/3~2/3 >2/3 χ2/P值
观察组 79 18(22.78) 30(37.97) 26(32.91) 5(6.33) 6.464/0.091
对照组 16 0(0) 5(31.25) 9(56.25) 2(12.5)  
1
中华医学会呼吸病学分会慢性阻塞性肺疾病学组，中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志，2021, 44(3): 170-205.
2
任成山，王关嵩，钱桂生. 慢性阻塞性肺疾病的成因及其治疗的困惑与希望[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(2): 127-141.
3
晏　妮，董俊康，张明周，等. 焦虑抑郁对慢性阻塞性肺疾病患者生活质量的影响及药物依从性中介作用[J/CD]. 中华肺部疾病杂志(电子版), 2022, 15(6): 771-775.
4
中华医学会，中华医学会杂志社，中华医学会全科医学分会，等. 成人社区获得性肺炎基层诊疗指南(2018年)[J]. 中华全科医师杂志，2019, 18(2): 117-126.
5
戴媛媛，马筱玲. 宏基因组二代测序技术在临床病原学诊断中的应用[J]. 临床检验杂志，2021, 39(1): 1-5.
6
缪　青，马玉燕，胡必杰. 基于宏基因二代测序技术检测呼吸道病毒的临床应用[J]. 中华医院感染学杂志，2018, 28(12): 1908-1912.
7
中华医学会呼吸病学分会. 肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)[J]．中华结核和呼吸杂志，2017, 40(8): 578-583.
8
中华医学会细菌感染与耐药防治分会. 呼吸系统感染中宏基因组测序技术临床应用与结果解读专家共识[J]. 中华临床感染病杂志，2022, 15(2): 90-102.
9
Pires N, Pinto P, Marçal N, et al. Pharmacological treatment of COPD-New evidence[J]. Pulmonology, 2019, 25(2): 90-96.
10
Barker BL, Haldar K, Patel H, et al. Association between pathogens detected using quantitative polymerase chain reaction with airway inflammation in COPD at stable state and exacerbations[J]. Chest, 2015, 147(1): 46-55.
11
Grudzinska FS, Aldridge K, Hughes S, et al. Early identification of severe community-acquired pneumonia: a retrospective observational study[J]. BMJ Open Respir Res, 2019, 6(1): e000438.
12
Mou S, Zhang W, Deng Y, et al. Comparison of CRP, procalcitonin，neutrophil counts, eosinophil counts, sTREM-1, and OPN between pneumonic and nonpneumonic exacerbations in COPD patients[J]. Can Respir J, 2022, 2022: 7609083.
13
Schuetz P, Beishuizen A, Broyles M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use[J]. Clin Chem Lab Med, 2019, 57(9): 1308-1318.
14
Kim YJ, Lim B, Kyung SY, et al. Comorbidity and inflammatory markers may contribute to predict mortality of high-risk patients with chronic obstructive pulmonary disease exacerbation[J]. J Clin Med Res, 2016, 8(7): 531-536.
15
Lanks CW, Musani AI, Hsia DW. Community-acquired pneumonia and hospital-acquired pneumonia[J]. Med Clin North Am, 2019, 103(3): 487-501.
16
Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults: An update[J]. Indian J Med Res, 2020, 151(4): 287-302.
17
刘　策，叶　芳. 我国社区获得性肺炎病原学分布特点[J]. 中国医药导报，2016, 13(15): 55-58.
18
刘　青. 老年社区获得性肺炎临床特点及危险因素分析[J]. 中华医院感染学杂志，2013, 23(13): 3101-3103.
19
Lai YC, Lu MC, Hsueh PR. Hypervirulence and carbapenem resistance：two distinct evolutionary directions that led high-risk Klebsiella pneumoniae clones to epidemic success[J]. Expert Rev Mol Diagn, 2019, 19(9): 825-837.
20
Wark PA, Tooze M, Powell H, et al. Viral and bacterial infection in acute asthma and chronic obstructive pulmonary disease increases the risk of readmission[J]. Respirology, 2013, 18(6): 996-1002.
21
Han D, Li Z, Li R, et al. mNGS in clinical microbiology laboratories：on the road to maturity[J]. Crit Rev Microbiol, 2019, 45(5-6): 668-685.
22
Chen X, Cao K, Wei Y, et al. Metagenomic next-generation sequencing in the diagnosis of severe pneumonias caused by Chlamydia psittaci[J]. Infection, 2020, 48(4): 535-542.
23
宋元林，张洪春，刘清泉，等. 重症社区获得性肺炎治疗的现状与展望[J]. 中华危重病急救医学，2019, 31(6): 665-668.
24
黄文杰，徐　虹，李伟峰，等. 初始细菌学检测在非重症社区获得性肺炎中的诊治价值[J]. 广东医学，2003, 24(1): 45-46.
25
Qu J, Zhang J, Chen Y, et al. Aetiology of severe community acquired pneumonia in adults identified by combined detection methods: a multi-centre prospective study in China[J]. Emerg Microbes Infect, 2022, 11(1): 556-566.
26
Klooster K, ten Hacken NH, Hartman JE, et al. [Bronchoscopic interventions in severe COPD: improvement of pulmonary function, exercise capacity and quality of life][J]. Ned Tijdschr Geneeskd, 2015, 159: A8497.
27
Zhu Y, Zheng X, Huang K, et al. Mortality prediction using clinical and laboratory features in elderly patients with severe community-acquired pneumonia[J]. Ann Palliat Med, 2021, 10(10): 10913-10921.
28
Gera K, Roshan R, Varma-Basil M, et al. Chronic pneumonia due to Klebsiella oxytoca mimicking pulmonary tuberculosis[J]. Pneumonol Alergol Pol, 2015, 83(5): 383-386.
29
邓晓慧，田　巍，葛晓竹，等. 纤维支气管镜吸痰联合肺泡灌洗对高龄慢性阻塞性肺疾病合并重症肺炎患者的疗效观察[J]．中国医药，2021, 16(4): 535-539.
30
文富强，申永春. 基于线粒体动力学的慢性阻塞性肺疾病发病机制与保护策略[J]. 西南医科大学学报，2022, 45(5): 369-372.
[1] 段燕, 郭欣, 吕慧芳, 王国利, 黄明光, 董英俊. 乳腺癌患者辅助化疗后感染肺孢子菌一例[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 318-321.
[2] 罗晨, 宗开灿, 李世颖, 傅应亚. 微小RNA-199a-3p调控CD4＋T细胞表达参与肺炎支原体肺炎患儿免疫反应研究[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 569-574.
[3] 唐英俊, 李华娟, 王赛妮, 徐旺, 刘峰, 李羲, 郝新宝, 黄华萍. 人脐带间充质干细胞治疗COPD小鼠及机制分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 476-480.
[4] 徐丽玲, 卢玉宝, 赵彦, 任利, 李姝艺, 符娟, 康玲, 汪青松, 尤再春. COPD管理云平台的构建及临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 481-484.
[5] 李海明, 刘鸿飞, 李俊. 血清脂蛋白酶水平与COPD患者骨骼肌质量减少的关系[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 500-503.
[6] 周杉京, 诸葛金科, 王芳芳. 补肺活血胶囊对COPD患者cCor、ALD、Ang-Ⅱ的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 517-519.
[7] 吴庆华, 冒勇, 闫效坤. AECOPD并发AKI的危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 529-531.
[8] 芦丹, 杨硕, 刘旭. VEGF、HMGB1、hs-CRP/Alb在AECOPD伴呼吸衰竭中的变化及预后分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 532-534.
[9] 安钱, 徐彬, 陈志祥, 徐晶晶, 黄丹丹. PCT、CRP及SAA对呼吸机相关性肺炎病情严重程度和预后分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 544-546.
[10] 熊锋, 娄建丽. 慢性阻塞性肺疾病急性加重期预后的临床分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 550-553.
[11] 王庆, 张红联, 吴志勇. COPD合并多重耐药菌肺部感染预后危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 557-559.
[12] 林静, 陈芳, 刘小霞. COPD患者认知功能障碍影响因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 569-571.
[13] 李静静, 翟蕾, 赵海平, 郑波. 多囊肾合并囊肿的多重耐药菌感染一例并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(08): 920-923.
[14] 余林阳, 王美英, 李建斌, 楼骁斌, 谢思远, 马志忠, 齐海英, 李稼. 高原地区肺炎合并右心功能衰竭体征患儿的肺动脉压力和心脏形态与功能的特征[J]. 中华临床医师杂志(电子版), 2023, 17(05): 535-544.
[15] 于洋, 刘孝洁, 王丽娟, 高宇晨, 丁瑶, 敖虎山. 新冠肺炎常态化条件下心肺复苏培训模式初探[J]. 中华临床医师杂志(电子版), 2023, 17(04): 483-486.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号