摘要
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。
Abstract
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.
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