Etiological Characteristics of Lower Respiratory Tract Infection in Elderly Patients with AECOPD and its Relationship with Inflammation and Immune Balance
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 bacte-ria distribution and drug resistance of lower respiratory tract infection in elderly AECOPD patients were analyzed,and the levels of in-flammatory 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).Lo-gistic 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 in-dexes 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 resis-tance 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 AE-COPD.
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