摘要
目的分析难治性哮喘合并肺部感染患者肺泡灌洗液(BALF)与血清的炎症因子水平及BALF中病原菌培养结果。方法选择医院2014年12月-2016年1月收治的难治性哮喘合并肺部感染患者96例设为试验组,选取同期于医院行支气管肺泡灌洗检测者50例作为对照组,所有受检者均行支气管肺泡灌洗术获取BALF及血清中白细胞介素-6(IL-6)、IL-8、IL-10、肿瘤坏死因子-α(TNF-α)和病原菌。比较两组肺泡灌洗液和血清中炎症因子的差异,分析肺泡灌洗液中病原菌及药敏结果。结果试验组患者血清和BALF中的炎症因子IL-6、IL-8、IL-10、TNF-α分别为56.91±6.34)pg/ml和(108.33±18.44)pg/ml、(289.31±36.73)pg/ml和(421.78±48.54)pg/ml、(20.93±3.92)pg/ml和(13.92±1.51)pg/ml、(2.53±0.32)mg/ml和(2.72±0.43)mg/ml均高于对照组(P均<0.001)。试验组患者血清中的炎症因子IL-6、IL-8低于BALF中的水平(P<0.05);而IL-10高于BALF中的水平(P<0.05);TNF-α在血清和BALF中的水平比较差异无统计学意义。96份肺泡灌洗液培养分离出病原菌128株,其中革兰阳性菌42株占32.81%,以肺炎链球菌为主;革兰阴性菌82株占64.06%,以流感嗜血杆菌为主;真菌4株占3.13%。化脓性链球菌、肺炎链球菌、金黄色葡萄球菌三者对头孢拉定、头孢唑林的耐药率均超过50.00%;铜绿假单胞菌、流感嗜血杆菌、肺炎克雷伯菌三者对替考拉宁、头孢噻吩的耐药率均超过50.00%。结论难治性哮喘合并肺炎感染患者的血清和BALF炎症因子存在一定的差异,BALF炎症因子与感染的相关性更强,BALF炎症因子和病原菌检测对难治性哮喘合并肺部感染的诊治具有重要的指导价值。
OBJECTIVE To analyze alveolar lavage fluid （BALF）, serum inflammatory factor levels and cultivation results of pathogenic bacteria in patients with refractory asthma complicated with pulmonary infections. METHODS A total of 96 patients with refractory asthma complicated with pulmonary infections treated in our hos- pital from Dec. 2014 to Jan. 2016 were selected as observation group, and 50 cases of patients underwent bron- choalveolar lavage detection during the same period in the hospital were selected as control group. All subjects un- derwent bronchoalveolar lavage for bronchoalveolar lavage fluid （BALF） and serum interleukin -6 （IL-6）, inter- leukin -6-8 （IL-8）, interleukin -10 （IL-10）, tumor necrosis factor （TNF- alpha） and detection of pathogenic bac- teria. The differences of inflammatory factors in bronchoalveolar lavage fluid and serum were compared between the two groups, and the pathogenic bacteria and drug sensitivity results in bronchoalveolar lavage fluid were ana- lyzed.RESULTS The inflammatory factors in bronchoalveolar lavage fluid and serum of IL-6, IL-8, IL-10, and TNF- alpha of observation group were （56.91±6.34）pg/ml, （108.33±18.44）pg/ml, （289.31±36.73）pg/ml, （421.78±48.54）pg/ml and （20.93±3.92）pg/ml, （13.92±1.51）pg/ml, （2.53±0.32）pg/ml, （2.72±0.43）pg/ml, which were higher than those of control group （all P〈0.001）. The serum inflammatory cytokines of IL-6 and IL-8 in observation group were significantly lower than those in the BALF level （P〈0.05）, while IL-10 was significantly higher than that in the BALF level （P〈0.05）, and there was no significant difference in the level of TNF- alpha in serum and BALF. A total of 128 strains of pathogenic bacteria were isolated from 96 bronchoalveo- lar lavage fluid cultures, among which 42 strains were gram-positive bacteria, accounting for 32.81%, mainly Streptococcus pneumoniae, 82 strains were gram-negative bacteria, accounting for 64.06 G, mainly Haemophilus influenzae, and 4 strains were fungi, accounting for 3.13%. The resistant rates of Streptococcus pyogenes, S. pneumoniae and Staphylococcus aureus to cefradine and cefazolin were more than 50%, and the resistant rates of Pseudomonas aeruginosa , H.influenzae and Klebsiella pneumoniae to teicoplanin and cephalothin were all over 50%.CONCLUSION Serum and BALF inflammatory factors in patients with refractory asthma complicated with pneumonia infection have certain differences, BALF inflammatory factors are more associated with infections. The detection of BALF inflammatory factors and pathogenic bacteria have important guiding value for the diagnosis and treatment of refractory asthma complicated with pulmonary infections.
作者
李海燕
郑有光
韩利红
付爱国
曹义
高莉
LI Hai-yan;ZHENG You-guang;HAN Li-hong;FU Ai-guo;CAO Yi;GAO li(Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第3期355-359,共5页
Chinese Journal of Nosocomiology
关键词
难治性哮喘合并肺部感染
血清
肺泡灌洗液
炎症因子
病原菌培养
药敏试验
Refractory asthma complicated with pulmonary infection
Serum
Bronchoalveolar lavage fluid
In-flammatory factor
Pathogen culture
Drug sensitivity test
