Objective To investigate the relations between the human beta defensin-2 (HBD-2) and systemic inflammatory responses in patients with lower respiratory tract infection（LRTI）. Methods Eighty-one patients with confirmed LRTI including community-acquired pneumonia，acute exacerbation of chronic obstructive pulmonary disease or concurrent lung infection，and bronchiectasis concurrent infection were enrolled，and twenty healthy volunteers were included as control. Plasma concentrations of HBD-2，IL-1β，and IL-8 were assayed with ELISA method in all patients and controls. Furthermore the patients were divided into three groups according to the onset of disease:,ie.group A （shorter than 7 days），group B （7 to 14 days），and group C （more than 14 days）. The differences between these groups were compared. Correlation between HBD-2 and IL-1β or IL-8 concentrations was analyzed. Results HBD-2，IL-1β，white blood cell （WBC） of the peripheral blood in the patients with LRTI were all significantly higher than those in the healthy controls. HBD-2 and IL-1β increased in group A and group B，and decreased in group C comparing to the control group （Plt;0.05 respectively）. There was no significant difference of IL-8 in group A，B and C. HBD-2 showed a positive linear correlation with IL-1β （r=0.313，P=0.030） and no correlation with IL-8（Pgt;0.05）. Conclusions The plasma HBD-2 concentration is increased in LRTI patients，which may be a biomarker of systemic inflammation in the early or relative early course of LRTI.
【摘要】 目的 分析ICU患者院内下呼吸道感染的细菌分布情况,为临床用药提供依据。方法 对成都市第六人民医院2006年1月—2009年6月566例ICU院内下呼吸道感染患者的痰培养标本结果进行回顾性调查分析。结果 共分离出371株病原菌,其中革兰阴性杆菌235株,占63.34%;革兰阳性球菌62株,占16.71%;真菌74株,占19.95%。药敏结果显示,对常规青霉素类基本耐药,亚胺培南—西司他丁、美罗培南耐药菌株少见,对万古霉素耐药菌株尚未出现。结论 加强ICU呼吸道感染的病原菌监测极为必要,对临床抗生素的合理使用具有指导意义。
Objective To study the incidence and etiological distribution of lower respiratory tract infection (LRTI) after airway metal stent implantation in patients with malignant central airway obstruction (MCAO). Methods The clinical data of 149 patients with MCAO who underwent airway metal stent implantation in Department of Pulmonary and Critical Care Medicine of Hunan Provincial People's Hospital from April 2014 to April 2021 were selected for a retrospective study. The incidence of LRTI after treatment was counted. According to whether LRTI occurred after operation, they were divided into infected group and uninfected group. The clinical data of the two groups were compared and the influencing factors of LRTI were analyzed. Sputum samples and/or bronchoalveolar lavage fluid samples from patients infected with LRTI were collected for pathogen detection and drug susceptibility test, and the distribution and drug resistance of main pathogens were analyzed. Results A total of 149 patients who met the criteria were included in this study and the incidence of LRTI was 21.48%. People in the infected group was older than that in the uninfected one, and the proportion of people with a history of smoking, chemoradiotherapy, covered metal stents, and stent-related granulation tissue proliferation was higher, and the proportion of people with postoperative standardized aerosol inhalation was lower (P<0.05). Age, smoking history, chemoradiotherapy, covered metal stents, stent-related granulation tissue hyperplasia and postoperative standardized aerosol inhalation were all influencing factors of LRTI in these patients (P<0.05). A total of 38 pathogens were detected in 32 patients with LRTI. Gram negative bacteria, gram positive bacteria and fungi accounted for 68.42% (26/38), 21.05% (8/38) and 10.53% (4/38) respectively. Pseudomonas aeruginosa, the main Gram-negative bacteria, had no resistance to tobramycin, gentamicin and amikacin, but had high resistance to compound sulfamethoxazole, tigecycline and ampicillin; Klebsiella pneumoniae had low resistance to tobramycin, amikacin and tigecycline, and high resistance to cefotaxime, ciprofloxacin and cefepime; the main Gram-positive Staphylococcus aureus had no drug resistance to vancomycin, linezolid, compound sulfamethoxazole and quinuptin/dafuptin, but had high drug resistance to tetracycline, penicillin G, levofloxacin, oxacillin and ciprofloxacin; the main fungi Candida albicans showed no resistance to fluconazole, itraconazole, voriconazole, 5-fluorocytosine and amphotericin B. These results of pathogenic detection and drug susceptibility test contributed to the improvement of the rational application rate of antibiotics. Conclusions LRTI occurs in about a quarter of patients with MCAO after airway metal stent implantation. The pathogens are mainly Pseudomonas aeruginosa and Staphylococcus aureus. Antimicrobial treatment should be based on the results of etiological detection and drug susceptibility test.
Objective To evaluate the clinical effect and safety of Gankeshuangqing capsule in the treatment of acute upper respiratory infection (AURI).Methods A total of 144 patients with wind-heat syndrome (acute upper respiratory infection) were recruited and randomized into the Gankeshuangqing group (administered with Gankeshuangqing capsule and symptomatic treatment for 3 days) and the ribavirin group (administered with ribavirin tablets and symptomatic treatment for 3 days). And the severity scores of pathogenetic conditions, efficacy rates and adverse drug reaction were estimated at the end of the experiment. Results A total of 144 patients (72 in the Gankeshuangqing group, 72 in the ribavirin group) were enrolled in this trial, of whom 9 were dropped out (3 from the Gankeshuangqing group, 6 from the ribavirin group) and 11 were excluded (4 from the Gankeshuangqing group, 7 from the ribavirin group). A significant difference was observed in the rates of cure and excellence: 85.51% (59/69) for the Gankeshuangqing group, and 66.67% (44/66) for the ribavirin group, respectively (Plt;0.05) (FAS data set). A significant difference was observed in the rates of cure in fervescence, pharyngodynia and pars nasalis catarrhus symptome: 70.00%, 78.26%, 56.90% in the Gankeshuangqing group, and 40.38%, 51.52%, 36.21% in the ribavirin group, respectively (Plt;0.05) (FAS data set). There was no significant difference in the rates of cure in tussis between the two groups: 32.08% for the Gankeshuangqing group, and 34.00% for the ribavirin group, respectively (Pgt;0.05) (FAS data set). There were 2 adverse drug reactions observed in the ribavirin group, whose white blood cell count was decreased, but in the Gankeshuangqing group, no adverse drug reaction was found. Conclusion The results indicate that Gankeshuangqing Capsule shows a definite effect on wind-heat syndrome (acute upper respiratory infection) with good safety.
Objective To explore the application value of Mycoplasma pneumoniae （MP） rapid culture technique for diagnosis of lower respiratory tract infections （LRTIs ） inpatients. Methods 120 LRTIs inpatients in respiratory ward，Anzhen hospital from January 1，2010 to December 31，2010，were recruited in this study. Their pharynx swabs were obtained for rapid MP culture and the serum antibody detection of MP was performed by Gelatin particle agglutination method. Results There were 33 positive yields in 120 LRTIs patients by rapid culture method and 24 positive yields by serological assay. The positive rates were 27.5% and 20.0% respectively. There was no significant difference in the two detecting methods （Pgt;0.05）. Conclusions MP rapid culture method is a better early diagnostic method at the present. MP rapid culture method combined with serological detection can improve the positive yield and avoid missed diagnosis.
Objective To explore the distribution of bacteria among community acquired lower respiratory tract infection (LRTI) inpatients with underlying chronic respiratory tract diseases.Methods The clinical data，sputum culture and drug susceptibility results of 212 community acquired LRTI patients who were hospitalized during the period 2001-2005 were retrospectively analyzed.All patients had various underlying chronic respiratory tract diseases.Results A total of 229 strains of pathogens were detected，with the majority being gram negative bacteria.In pathogens of acute exacerbation of chronic obstructive pulmonary disease，gram negative bacteria occupied 73.9%.And Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common pathogens，with each occupying 18.2% and 13.6% respectively.Gram positive bacteria occupied 23.8%，mainly Staphylococcus aureus (10.2%) and Streptococcus pneumoniae (9.1%).In patients with bronchiectasis exacerbated by bacterial infection，86.2% were caused by gram negative bacteria，the top three being，in descending order，Pseudomonas aeruginosa (27.5%)，Haemophilus parainfluenzae (13.7%)，and Haemophilus influenzae (11.8%).Bronchiectasis was the major risk factor of getting Pseudomonas aeruginosa infection (OR=5.590，95%CI 2.792~11.192).The risk factors of getting Acinetobacter baumanii infection were antacid usage within 1 month (OR=9.652，95%CI 2.792~11.192) and hypoalbuminemia (OR=2.679，95%CI 1.108~6.476).For enterobacters infections，including Klebsiella pneumoniae，Enterobacter cloacae and Escherichia coli，the risk factors were antibiotic usage within 1 month (OR=4.236，95%CI 1.982~9.057)，having renal diseases (OR=4.305，95%CI 1.090~17.008) and diabetes mellitus (OR=2.836，95%CI 1.339~6.009).Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases.The pathogens were influenced by underlying diseases，severity of diseases and drug usage history of patients.
Objective To investigate the clinical features of lower respiratory tract infection caused by hypermastigote. Methods The clinical manifestations, chest imaging characteristics, fiber bronchoscopic and etiological test results were analyzed in 16 patients with hypermastigote infection in lower respiratory tract. Results In 16 patients with hypermastigote infection in lower respiratory tract, fever were present in all the cases, cough in 15 cases, night sweat in 12 cases, wheezing in 3 cases, and eosinophilia in 3 cases.Alive hypermastigotes were found in respiratory tract secretion in all the 16 cases. Bacterial culture of respiratory tract secretion yielded positive results in 8 of 16 cases. Chest imaging showed infiltrations in several lobes and segments or a large opacity with fuzzy patches. Bronchoscopy showed an acute inflammation in the respiratory tract lumen. Prognosis was good with the therapy of Metronidazole. Conclusions Detection of hypermastigote infection in lower respiratory tract have a definite clinical significance in Shenzhen area. Mixed infection is common in hypermastigote infection of lower respiratory tract.
至2002年6月,有关上呼吸道感染治疗的临床证据如下:①止痛剂/抗炎药用于缓解症状:1个系统评价发现与安慰剂比较止痛剂或抗炎药在1～5 d时显著减轻咽喉炎症状;1个RCT发现在服用抗生素的急性鼻窦炎患者,激素鼻喷剂较安慰剂明显改善症状,持续21 d.②抗生素用于预防β溶血链球菌咽炎的少见并发症:1个系统评价发现抗生素可预防β溶血链球菌咽炎的非化脓性并发症,但在工业化国家该并发症少见.③抗生素能缩短流感嗜血杆菌、卡他莫拉菌或肺炎链球菌感染的康复时间,在少部分患者中其上呼吸道感染由流感嗜血杆菌,卡他莫拉菌或肺炎链球菌引起.1个RCT发现抗生素较安慰剂明显增加这些患者在5 d时的康复.但目前尚无简捷的方法将此亚组患者从众多鼻咽培养阴性的患者中甄别出来.④抗生素缩短急性支气管炎、咽喉炎和鼻窦炎的康复时间:系统评价发现抗生素能轻度改善症状.与安慰剂比较,使用抗生素常出现副作用(恶心、呕吐、头痛、皮疹、阴道炎).⑤抗生素在感冒患者中的作用:2个系统评价发现,在患感冒6～14 d时使用抗生素在治愈率或全身改善方面与安慰剂没有差异.⑥抗组胺药用于流涕和喷嚏:1个系统评价发现,使用抗组胺药2 d后流涕和喷嚏明显减轻,但临床获益较小.⑦β受体激动剂缩短成人支气管高反应性、喘息或气流受限患者咳嗽的持续时间:1个系统评价发现,与安慰剂或红霉素比较,在7 d时β受体激动剂可减轻成人咳嗽症状,但亚组分析表明此种获益仅限于伴有支气管高反应性、喘息或气流受限者.β受体激动剂明显增加手抖、震颤和神经过敏的发生比例.儿童中进行的2个小样本RCTs发现在7 d时咳嗽症状在β受体激动剂和安慰剂间没有显著差异.但是,这些RCTs规模太小,故不能检出临床上重要的差异.⑧减充血剂用于充血症状的长期缓解:1个系统评价发现,无证据支持数天中反复使用减充血剂.1个病例对照研究发现,有微弱证据支持去甲麻黄碱可能增加出血性中风的风险.⑨减充血剂用于充血症状的短期缓解:1个系统评价发现,与安慰剂比较单剂减充血剂显著减轻鼻充血,持续3～10h.⑩紫锥花属用于预防:1个系统评价发现与不干预比较,紫锥花属显著减少一次感染发作的人数,但与安慰剂比较,无有效证据支持紫锥花属的作用.(11)紫锥花属制剂:2个系统评价发现有限证据支持紫锥花属的某些制剂在改善症状方面优于安慰剂,但我们未发现有效证据支持任何特定产品的疗效.(12)蒸汽吸入:1个系统评价发现,无证据支持蒸汽吸入的作用.(13)维生素C:1个系统评价发现与安慰剂比较维生素C可轻度缩短感冒症状持续时间,但该作用较小且可能是发表偏倚.(14)锌(鼻内锌胶或锭剂):2个RCTs发现,与安慰剂比较鼻内锌胶缩短感冒症状的平均持续时间,但仅有1个RCT发现差异有显著性.2个系统评价发现,与安慰剂比较葡萄糖酸锌或醋酸盐锌锭剂在7d时减轻症状的持续.
Objective To evaluate the therapeutic effect, safty and tolerance of Gankeshuangqing Capsule in the treatment of patients suffering from wind-heat syndrome (acute upper respiratory infection or acute bronchitis). Methods The clinical trials were designed multicentered, double blind, double dummy, randomized and parallel positive drug controlled. A total of 289 patients participated in the trials. Those who suffered from acute upper respiratory infection were given throat virus-detection to make a definite diagnosis of the origins of disease. Results Among the 40 patients who were diagnosed with virus infection, 81.82% in Gankeshuangqing group were healed, but only 50.00% in control group, and significant differences were observed between the two groups (Plt;0.05). At the end of the third day of treatment, the rates of cure and excellence in patients suffering from acute upper respiratory infection were 80.00% in Gankeshuangqing group, and 68.57% in control group, and both groups showed good therapeutic effect，but there was no significant difference between the two groups (Pgt;0.05). At the end of the seventh day of treatment, the rates of cure and excellence in patients suffering from acute bronchitis were 82.35% in Gankeshuangqing group, and 63.77% in control group, and both groups showed good therapeutic effect, and there were significant differences between the two groups (Plt;0.05)；only one patient in Gankeshuangqing group had constipation during the treatment, but there was no evidence showing that it is caused by Gankeshuangqing. Conclusion The results show that Gankeshuangqing Capsule has a definite effect on wind-heat syndrome (acute upper respiratory infection or acute bronchitis) with good safety.
呼吸道感染在感染性疾病中占有重要地位，细菌性肺炎是呼吸道感染中的主要代表性疾病，最重要的治疗措施是抗菌治疗，用药选择及方法正确与否直接影响治疗的成败。同时如何降低医疗费用也是临床医生需要考虑的棘手问题。据国外文献报道在英国每年约有5亿张以上的抗微生物药物处方，其中住院处方中约40％为静脉制剂，而我国住院静脉制剂的处方比例则更高。医疗费用的增加部分与静脉用药过多有关。为寻求解决临床治疗与医疗费用之间的矛盾，选择高效、低毒、廉价的抗菌药物，1987年Quintiliani等[1]首先提出了抗生素序贯疗法（sequential therapy）的概念，即在经过相对短疗程（48～72 h）静脉抗菌药物治疗，临床症状基本稳定或改善后，改为口服抗菌药物治疗。口服的抗菌药物可以是与前者完全相同的口服剂型，也可以是同一类或抗菌谱相似的同一级药物，后也有人称之为"转换治疗"（switch therapy）、"降级治疗"（step-down therapy）。据国外文献报道，住院的社区获得性肺炎（CAP）应用序贯疗法者因早期出院每位患者节约费用293~1393美元[2-4]。