【摘要】 目的：探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者痰培养与铁标志物和炎症指标的关系，为AECOPD患者抗感染治疗提供指导。方法：将江门市新会区中医院2020年6月-2022年2月呼吸内科住院部接收的痰培养阳性AECOPD患者122例作为阳性组，同期选择122例痰培养阴性的AECOPD患者作为阴性对照组。采用VITEK2 Compact全自动细菌鉴定仪检测痰培养病原菌类型，采用罗氏Cobasc702全自动生化分析仪检测血清铁（SI）、血清铁蛋白（SF）、转铁蛋白（TRF）、血清淀粉样蛋白A(SAA)和超敏C反应蛋白（hs-CRP）；采用万孚免疫荧光层析定量系统FS-113检测降钙素原（PCT）；采用Sysmex XS-1000i全自动血细胞分析仪检测白细胞计数（WBC）、中性粒细胞（NE）百分比。结果：122例痰培养阳性AECOPD患者中，细菌感染110例，占比90.16%，其中革兰阳性（G+）菌37例，占比30.33%，革兰阴性（G-）菌73例，占比59.84%，真菌感染12例，占比9.84%;G+菌种以金黄色葡萄球菌及肺炎链球菌为主，G-菌种以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌为主，真菌感染以白色念珠菌感染为主。真菌感染组及细菌感染组的SI、TRF水平均低于阴性对照组，真菌感染组及细菌感染组的SF水平均高于阴性对照组，差异均有统计学意义（P<0.05）。真菌感染组及细菌感染组的WBC、hs-CRP、PCT、NE及SAA水平均高于阴性对照组，差异均有统计学意义（P<0.05）。AECOPD患者的SI、TRF与WBC、hs-CRP、PCT、NE及SAA均呈负相关，SF与WBC、hs-CRP、PCT、NE及SAA均呈正相关（P<0.05）。不同铁代谢指标在预测AECOPD患者痰培养结果阳性的价值为SF>TRF>SI(P<0.05)；不同铁代谢指标在预测AECOPD患者痰培养为真菌的预测价值为SF>TRF(P<0.05)。结论：AECOPD痰培养阳性患者的SI、TRF低于痰培养阴性的AECOPD患者，SF高于痰培养阴性AECOPD患者；AECOPD患者的SI、TRF、SF与WBC、hs-CRP、PCT、NE及SAA有一定的相关性；SI、SF及TRF可用于早期预测AECOPD患者痰培养阳性结果，而SF及TRF在鉴别AECOPD患者真菌与细菌感染有一定的价值。更多还原

【Abstract】 Objective: To explore the relationship between sputum culture and iron markers and inflammatory indexes in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to provide guidance for anti-infective treatment of patients with AECOPD. Method: A total of 122 patients with positive sputum culture of AECOPD who were admitted to the Inpatient Department of Respiratory Medicine of Jiangmen Xinhui District Hospital of Traditional Chinese Medicine from June 2020 to February 2022 as the positive group and 122 patients with negative sputum culture of AECOPD as the negative control group during the same period were selected. The types of pathogens in sputum culture were detected by VITEK2 Compact automatic bacterial identification instrument. The serum iron(SI), serum ferritin(SF), transferrin(TRF), serum amyloid A(SAA) and high-sensitivity C reactive protein(hs-CRP) were detected by Roche Cobasc702 automatic biochemical analyzer. Procalcitonin(PCT) was detected by Wanfu immunofluorescence chromatography quantitative system FS-113. The white blood cell count(WBC) and the percentage of neutrophils(NE) were detected by Sysmex XS-1000i automatic blood cell analyzer. Result: Among 122 patients with positive sputum culture AECOPD, there were 110cases of bacterial infection, accounting for 90.16%, including 37 cases of Gram-positive(G+) bacteria, accounting for 30.33%, 73 cases of Gram-negative(G-) bacteria, accounting for 59.84%, and 12 cases of fungal infection,accounting for 9.84%. G+ strains were mainly staphylococcus aureus and streptococcus pneumoniae, G-strains were mainly Acinetobacter baumannii, pseudomonas aeruginosa and Klebsiella pneumoniae, and fungal infections were mainly candida albicans. The levels of SI and TRF in fungal infection group and bacterial infection group were lower than those in negative control group, while the levels of SF in fungal infection group and bacterial infection group were higher than those in negative control group, the differences were statistically significant(P<0.05). The levels of WBC, hs-CRP, PCT, NE and SAA in fungal infection group and bacterial infection group were higher than those in negative control group, the differences were statistically significant(P<0.05). SI and TRF were negatively correlated with WBC, hs-CRP, PCT, NE and SAA, while SF was positively correlated with WBC, hs-CRP, PCT,NE and SAA(P<0.05). The values of different iron metabolism indexes in predicting the positive sputum culture results of AECOPD patients were SF>TRF>SI(P<0.05). The predictive value of different iron metabolism indexes in predicting the fungal culture in sputum of AECOPD patients was SF>TRF(P<0.05). Conclusion: The SI and TRF of AECOPD patients with positive sputum culture are lower than those of AECOPD patients with negative sputum culture, and SF is higher than that of AECOPD patients with negative sputum culture. SI, TRF and SF of AECOPD patients are correlated with WBC, hs-CRP, PCT, NE and SAA. SI, SF and TRF can be used to predict the positive sputum culture results of AECOPD patients in the early stage, while SF and TRF have certain value in identifying fungal and bacterial infections in AECOPD patients.更多还原