老年慢性阻塞性肺疾病合并肺部感染患者的病原菌分布特点及其血清PLTP、FGF9、MUC1变化意义初探

Preliminary study on distribution characteristics of pathogenic bacteria and significance of changes in the levels of serum PLTP,FGF9 and MUC1 in elderly patients with chronic obstructive pulmonary disease complicated with pulmonary infection

中文关键词: 肺疾病  慢性阻塞性  肺部感染  病原菌  磷脂转移蛋白质类  成纤维细胞生长因子9  黏蛋白-1

英文关键词: pulmonary disease  chronic obstructive  pulmonary infection  pathogenic bacteria  phospholipid transfer protein  fibroblast growth factor 9  mucin-1

中文摘要:

      目的 探讨老年慢性阻塞性肺疾病(COPD)合并肺部感染患者病原菌分布特点,血清磷脂转运蛋白(PLTP)、成纤维细胞生长因子 9(FGF9)、黏蛋白 1(MUC1)水平变化的意义.方法 选择医院 2024 年 4 月至 2025 年 4 月收治的120 例老年 COPD 合并肺部感染患者作为感染组,另选择同期124 例老年 COPD 无肺部感染患者作为未感染组.采用酶联免疫吸附测定试剂盒检测血清PLTP、FGF9、MUC1 的水平,治疗前收集患者痰液标本,培养病原体并鉴定.感染组根据预后分为生存组(n=97)与死亡组(n=23);血清 PLTP、FGF9、MUC1 水平及 COPD 全球倡议(GOLD)分级与老年 COPD合并肺部感染患者预后的关系采用相对危险度分析;受试者工作特征曲线分析血清 PLTP、FGF9、MUC1 水平对老年COPD 合并肺部感染患者预后的预测价值.结果 感染组较未感染组血清 PLTP、MUC1 水平升高,FGF9 水平下降(P<0.05);老年 COPD 合并肺部感染患者经痰培养分离病原菌共143 株,其中革兰氏阴性菌 70 株(48.95%),革兰氏阳性菌64 株(44.76%),真菌9 株(6.29%);死亡组较生存组 GOLD 分级Ⅲ级患者比例及血清 PLTP、MUC1 水平及 CURB-65 评分升高,血清 FGF9 水平下降(P<0.05);血清 PLTP、FGF9、MUC1 高水平和 GOLD 分级Ⅲ级患者发生死亡的风险分别是PLTP、FGF9、MUC1 低水平和 GOLD 分级Ⅰ～Ⅱ级患者的 3.482 倍(95%CI:1.382～8.772)、0.211 倍(95%CI:0.076～0.582)、6.032 倍(95%CI:1.892～19.230)和3.257 倍(95%CI:1.293～8.204);血清 PLTP、FGF9、MUC1 水平单独及联合预测老年COPD合并肺部感染患者死亡的曲线下面积分别为0.860、0.868、0.868、0.961,联合预测的曲线下面积更高(P<0.05).结论 老年 COPD 合并肺部感染患者的病原菌以革兰氏阴性菌和革兰氏阳性菌为主,其中预后不良患者血清PLTP、MUC1 水平升高,FGF9 水平下降,联合检测这3 项指标,可以提高预后预测的准确性.

英文摘要:

      Objective To investigate the distribution characteristics of pathogenic bacteria and the significance of changes in the levels of serum phospholipid transfer protein(PLTP),fibroblast growth factor 9(FGF9),and mucin 1(MUC1)in elderly patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary infection.Methods A total of 120 elderly COPD patients with pulmonary infection admitted to hospital from April 2024 to April 2025 were selected as infection group.Another 124 elderly COPD patients without pulmonary infection during the same period were selected as non-infection group.The levels of serum PLTP,FGF9,and MUC1 were detected using an enzyme-linked immunosorbent assay kit.The sputum samples were collected from patients before treatment for pathogen culture and identification.The patients in the infection group were further divided into survival group(n=97)and death group(n=23)based on their prognosis.The relationship between the levels of serum PLTP,FGF9,MUC1 and global initiative for chronic obstructive lung disease(GOLD)stage and the prognosis of elderly COPD patients with pulmonary infection was analyzed using relative risk analysis.The receiver operating characteristic curve was used to analyze the predictive value the levels of serum PLTP,FGF9,and MUC1 for the prognosis of elderly COPD patients with pulmonary infection.Results The levels of serum PLTP and MUC1 in the infectiongroup were higher than those in the non-infected group,while the level of FGF9 was lower(P<0.05).A total of 143 strains of pathogens were isolated from sputum cultures of elderly COPD patients with pulmonary infection,including 70 strains of Gram-negative bacteria(48.95％),64 strains of Gram-positive bacteria(44.76％),and 9 strains of fungi(6.29％).Compared with the survival group,the death group had a higher proportion of patients with GOLD stage Ⅲ,higher levels of serum PLTP and MUC1,higher CURB-65 scores,and lower level of serum FGF9(P<0.05).The risk of death for patients with high levels of serum PLTP,MUC1,and GOLD stage Ⅲ was 3.482 times(95％CI:1.382--8.772),0.211 times(95％CI:0.076--0.582),6.032 times(95％CI:1.892--19.230),and 3.257 times(95％CI:1.293--8.204)that of patients with low levels of serum PLTP,MUC1,and GOLD stages Ⅰ--Ⅱ,respectively.The area under the curve(AUC)for levels of serum PLTP,FGF9,and MUC1 individually and in combination for predicting death in elderly COPD patients with pulmonary infection were 0.860,0.868,0.868,and 0.961,respectively.The combined prediction had a higher AUC(P<0.05).Conclusion The pathogens in elderly COPD patients with pulmonary infection are predominantly Gram-negative and Gram-positive bacteria.Patients with poor prognosis show elevated levels of serum PLTP and MUC1,and decreased levels of serum FGF9.Combined detection of these three indicators can improve the accuracy of prognosis prediction.