CAJ | 학술논문

目的：研究老年慢性阻塞性肺疾病（ COPD）稳定期患者下呼吸道细菌定植与细胞免疫之间的相互关系。方法纳入2011年1月-2012年12月在首都医科大学附属复兴医院呼吸科慢病管理人群中诊断明确的老年（年龄≥65岁） COPD稳定期患者50例（观察组），对其诱导痰液进行细菌学定量，测定痰及血中白介素8（IL-8）、高敏C反应蛋白（ hs-CRP）和细胞免疫因子（ CD4＋、 CD8＋和CD4＋/CD8＋）的水平，并与同期在体检中心招募的同年龄段健康志愿者30例（对照组）进行比较。结果共入选患者50例，其下呼吸道细菌定植率为64.0％，致病菌主要是流感嗜血杆菌、肺炎链球菌、卡他莫拉菌、副流感嗜血杆菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌及真菌，分别占27.8％、16.7％、13.9％、11.1％、8.3％、8.3％、5.6％、5.6％、2.7％，其中4例合并2种定植菌占11.1％。老年COPD稳定期细菌定植患者痰IL-8、血IL-8及血hs-CRP水平分别为（408.73±286.09） ng/L、（63.49±42.98） ng/L、（12.15±8.13） mg/L，无细菌定植患者痰IL-8、血IL-8及血hs-CRP水平分别为（242.61±85.52） ng/L、（36.66±11.91） ng/L、（6.50±3.97） mg/L，两组相比差异有统计学意义（P＜0.05）。对照组CD4＋、 CD8＋和CD4＋/CD8＋值分别为（38.40±4.92）％、（24.32±8.76）％、（1.89±0.90），其中细菌定植患者分别为（36.37±8.26）％、（28.96±7.45）％、（1.29±0.27），无细菌定植患者分别为（25.06±5.97）％、（36.44±9.30）％、（0.73±0.31），三组间差异有统计学意义（ P＜0.05）。结论部分老年COPD稳定期患者存在下呼吸道细菌的定植，而且可以出现一种以上致病菌的定植；细菌定植患者存在明显的气道炎性反应和免疫功能缺陷，这三者之间可能相互影响导致COPD急性加重趋于频繁。
목적：연구노년만성조새성폐질병（ COPD）은정기환자하호흡도세균정식여세포면역지간적상호관계。방법납입2011년1월-2012년12월재수도의과대학부속복흥의원호흡과만병관리인군중진단명학적노년（년령≥65세） COPD은정기환자50례（관찰조），대기유도담액진행세균학정량，측정담급혈중백개소8（IL-8）、고민C반응단백（ hs-CRP）화세포면역인자（ CD4＋、 CD8＋화CD4＋/CD8＋）적수평，병여동기재체검중심초모적동년령단건강지원자30례（대조조）진행비교。결과공입선환자50례，기하호흡도세균정식솔위64.0％，치병균주요시류감기혈간균、폐염련구균、잡타막랍균、부류감기혈간균、대장애희균、동록가단포균、금황색포도구균、포만불동간균급진균，분별점27.8％、16.7％、13.9％、11.1％、8.3％、8.3％、5.6％、5.6％、2.7％，기중4례합병2충정식균점11.1％。노년COPD은정기세균정식환자담IL-8、혈IL-8급혈hs-CRP수평분별위（408.73±286.09） ng/L、（63.49±42.98） ng/L、（12.15±8.13） mg/L，무세균정식환자담IL-8、혈IL-8급혈hs-CRP수평분별위（242.61±85.52） ng/L、（36.66±11.91） ng/L、（6.50±3.97） mg/L，량조상비차이유통계학의의（P＜0.05）。대조조CD4＋、 CD8＋화CD4＋/CD8＋치분별위（38.40±4.92）％、（24.32±8.76）％、（1.89±0.90），기중세균정식환자분별위（36.37±8.26）％、（28.96±7.45）％、（1.29±0.27），무세균정식환자분별위（25.06±5.97）％、（36.44±9.30）％、（0.73±0.31），삼조간차이유통계학의의（ P＜0.05）。결론부분노년COPD은정기환자존재하호흡도세균적정식，이차가이출현일충이상치병균적정식；세균정식환자존재명현적기도염성반응화면역공능결함，저삼자지간가능상호영향도치COPD급성가중추우빈번。
Objective To investigate the relationship between lower airway bacterial colonization ( LABC) and airway inflammation or cellular immunity of stable phase COPD patients.Methods 50 elderly stable phase COPD patients ( aged≥65 years) with clear diagnosis in the department of respiratory (observed group), Fuxing Hospital Affiliated to Capital University of Medical Sciences between January 2011 to December 2012 was compared with 30 recruiting healthy people in the same age who re-ceived health examination in the medical examination center ( control group ) on interleukin ( IL) -8, hs-CRP, CD4 +, CD8 +and CD4 +/CD8 +in the induced sputum , after monitored quantitative bacterial culture , and blood.Results Among the 50 subjects, 64.0%showed LABC with bacterial loads >106cfu/ml.Pathogenic bacteria included Hemophilus influenza (27.8%), Streptococcus pneumoniae ( 16.7%) , Catarrhal Moran bacteria ( 13.9%) , Hemophilus parainfluenza ( 11.1%) , Bacillus coil ( 8.3%) , Pseudomonas aeruginosa ( 8.3%) , Staphylococcus aureus ( 5.6%) , Baumanii ( 5.6%) and Fungus (2.7%) .4 cases were with two kinds of pathogens (11.1%).The concentration of IL -8 in sputum and IL-8 and hs-CRP in blood of the patients with LABC were (408.73 ±286.09)ng/L, (63.49 ±42.98) ng/L, (12.15 ±8.13) mg/L and were (242.61 ±85.52) ng/L, (36.66 ±11.91) ng/L, (6.50 ±3.97) mg/L of the patients without LABC respectively.Significant difference was found in the two groups (P<0.05) .The levels of CD4 +, CD8 +and CD4 +/CD8 +were (38.40 ±4.92)%、(24.32 ±8.76)%、 (1.89 ±0.90) in healthy group.The levels of CD4 +, CD8 +and CD4 +/CD8 +were (36.37 ±8.26)%、(28.96 ±7.45)%、 (1.29 ±0.27) in group with LABC and (25.06 ±5.97)%、 (36.44 ±9.30)%、 (0.73 ±0.31) in group without LABC.Significant difference were found in these three groups ( P<0.05 ) .Conclusion LABC is found in a good portion of elderly stable COPD patients.It can appear more than one bacterial colonization.Stable COPD with LABC patients clear-ly suffer from airway inflammation and immunodeficiency and they three might influence each other and lead to exacerbations of COPD.