| 于 爽,张玉娇,王娜娜,高 璠,谭效锋,刘美蓉.老年AECOPD患者下呼吸道感染的病原学特征及与炎症免疫平衡的关系研究[J].,2024,(14):2650-2655 |
| 老年AECOPD患者下呼吸道感染的病原学特征及与炎症免疫平衡的关系研究 |
| Etiological Characteristics of Lower Respiratory Tract Infection in Elderly Patients with AECOPD and its Relationship with Inflammation and Immune Balance |
| 投稿时间：2024-01-09 修订日期：2024-01-31 |
| DOI：10.13241/j.cnki.pmb.2024.14.009 |
| 中文关键词: 老年 AECOPD 下呼吸道感染 病原学 炎症免疫平衡 危险因素 预测效能 |
| 英文关键词: Elderly AECOPD Lower respiratory tract infection Etiology Inflammatory immune balance Risk factors Predictive effectiveness |
| 基金项目:国家自然科学基金项目（81301605） |
|
| 摘要点击次数: 408 |
| 全文下载次数: 259 |
| 中文摘要: |
| 摘要 目的：探讨老年慢性阻塞性肺疾病急性加重期（AECOPD）患者下呼吸道感染的病原学特征及与炎症免疫平衡的关系，以期为老年AECOPD患者下呼吸道感染的诊治提供参考。方法：选取2020年6月～2023年6月我院收治的AECOPD患者下呼吸道感染80例为试验组，另选取同期未发生下呼吸道感染80例为对照组。分析老年AECOPD患者下呼吸道感染的病原菌分布和耐药性，比较两组炎症因子[降钙素原（PCT）、肿瘤坏死因子（TNF-α）、白介素6（IL-6）]及T细胞亚群（CD3+、CD4+、CD4+/CD8+）水平差异，Logistic回归分析老年AECOPD患者下呼吸道感染的影响因素，接收者工作特征曲线（ROC）分析法探讨相关指标对老年AECOPD患者下呼吸道感染的预测效能。结果：80例老年AECOPD下呼吸道感染患者共检出91株病原菌，其中革兰阴性杆菌83株（91.21%），革兰阳性球菌7株（7.69%%），真菌1株（1.10%）。铜绿假单胞菌、肺炎克雷伯菌对哌拉西林、左氧氟沙星、环丙沙星以外的抗生素耐药率均低于30%；鲍曼不动杆菌耐药率普遍较高；大肠埃希菌对美罗培南、亚胺培南、阿米卡星耐药率较低。相较于对照组，试验组血清PCT、TNF-α、IL-6水平较高，血清CD3+、CD4+、CD4+/CD8+水平较低（P＜0.05）。Logistic回归分析显示，机械通气、低蛋白血症、糖尿病及高水平PCT、TNF-α、IL-6为老年AECOPD患者下呼吸道感染危险因素，高水平CD4+/CD8+为老年AECOPD患者下呼吸道感染保护因素（P＜0.05）。ROC分析显示：部分炎症因子、T细胞亚群及临床特征等8项指标单独及联合应用时的曲线下面积（AUC）分别为0.651、0.650、0.644、0.703、0.734、0.737、0.769、0.890，显见联合应用诊断效能很高。结论：老年AECOPD患者下呼吸道感染主要为革兰阴性杆菌，且耐药形势较为严峻；机械通气、低蛋白血症、糖尿病是老年AECOPD患者下呼吸道感染的影响因素，同时炎症免疫失衡参与了老年AECOPD患者下呼吸道感染的发生发展。基于部分炎症因子、T细胞亚群及临床特征等8项指标联合应用对老年AECOPD患者下呼吸道感染的预测效能较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the etiological characteristics of lower respiratory tract infection in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its relationship with inflammation and immune balance, in order to provide reference for diagnosis and treatment of lower respiratory tract infection in elderly patients with AECOPD. Methods: 80 cases of lower respiratory tract infection in AECOPD patients admitted to our hospital from June 2020 to June 2023 were selected as the test group, and 80 cases without lower respiratory tract infection in the same period were selected as the control group. The pathogenic bacteria distribution and drug resistance of lower respiratory tract infection in elderly AECOPD patients were analyzed, and the levels of inflammatory factors[procalcitonin (PCT), tumor necrosis factor(TNF-α), interleukin-6(IL-6)] and T cell subsets (CD3+, CD4+, CD4+/CD8+) between the two groups were compared. Logistic regression analysis was conducted to analyze the influencing factors of lower respiratory tract infection in elderly AECOPD patients, and receiver operating characteristic curve (ROC) analysis was used to explore the predictive efficacy of relevant indicators in elderly AECOPD patients. Results: A total of 91 pathogenic bacteria were detected in 80 elderly patients with lower respiratory tract infection of AECOPD, including 83 gram negative bacilli (91.21%), 7 gram positive cocci(7.69%%) and 1 fungus (1.10%). The resistance rates of pseudomonas aeruginosa and klebsiella pneumoniae to antibiotics other than piperacillin, levofloxacin and ciprofloxacin were all lower than 30%. The drug resistance rate of acinetobacter baumannii was generally high. The resistance rate of escherichia coli to meropenem, imipenem and amikacin was low. Compared with the control group, the levels of serum PCT, TNF-α and IL-6 in experimental groups were higher, and the levels of serum CD3+, CD4+ and CD4+/CD8+ were lower (P<0.05). Logistic regression analysis showed that mechanical ventilation, hypoproteinemia, diabetes and high levels of PCT, TNF-α and IL-6 were risk factors for lower respiratory tract infection in elderly AECOPD patients, and high levels of CD4+/CD8+ were protective factors for lower respiratory tract infection in elderly AECOPD patients(P<0.05). ROC analysis showed that the area under the curve (AUC) of 8 indexes including some inflammatory factors, T cell subpopulations and clinical features were 0.651, 0.650, 0.644, 0.703, 0.734, 0.737, 0.769 and 0.890 when applied alone and in combination, respectively, indicating high diagnostic efficiency of combined application. Conclusion: The main lower respiratory tract infection in elderly patients with AECOPD is gram negative bacteria, and the drug resistance situation is serious. Mechanical ventilation, hypoproteinemia and diabetes are the factors affecting lower respiratory tract infection in elderly patients with AECOPD. Meanwhile, inflammatory immune imbalance is involved in the occurrence and development of lower respiratory tract infection in elderly patients with AECOPD. The combined application of 8 indexes including some inflammatory factors, T cell subsets and clinical characteristics has a high predictive effect on lower respiratory tract infection in elderly patients with AECOPD. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
