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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
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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/OL]. 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/OL]. 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)  
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