|
老年AECOPD患者病因及抗生素治疗的研究进展
|
Abstract:
慢性阻塞性肺疾病(Chronic obstructive pulmonary disease, COPD)是一种呼吸内科十分常见的、可以预防和治疗的肺部疾病。随着人口老龄化时代的来临,慢阻肺在我国老年人群中具有高患病率及高死亡率等特点。呼吸道症状的急剧恶化称之为慢阻肺急性加重,可由多种因素导致。其中病原菌的感染是慢阻肺急性加重的最主要原因,抗生素的合理使用能够显著有效地缩短病程减少并发症。为了更好地预防和治疗慢阻肺,本文通过查阅国内外文献,对老年AECOPD患者病因及抗生素治疗的研究进展进行综述。
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable lung disease that is very common in respiratory medicine. With the age of aging population coming, COPD has the characteristics of high morbidity and high mortality among the aged population. A sharp worsening of respiratory symptoms is called an acute exacerbation of COPD and can be caused by a number of factors. Among them, the infection of pathogenic bacteria is the main cause of acute exacerbation of COPD. Rational use of antibiotics can significantly shorten the course of disease and reduce complications. In order to better prevent and treat COPD, this article reviews the research progress of risk factors and antibiotic treatment of elderly patients with AECOPD by referring to domestic and foreign relevant literature.
[1] | 侯珊珊, 施劲东, 尹欣, 等. 1990-2019年中国慢性阻塞性肺疾病的疾病负担情况分析[J]. 中华流行病学杂志, 2022, 43(10): 1554-1561. |
[2] | Liang, C., Mao, X., Niu, H., et al. (2021) Characteristics, Management and In-Hospital Clinical Outcomes among Inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in China: Re-sults from the Phase I Data of ACURE Study. The International Journal of Chronic Obstructive Pulmonary Disease, 16, 451-465.
https://doi.org/10.2147/COPD.S281957 |
[3] | 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会, 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 《慢性阻塞性肺疾病诊治指南(2021年修订版)》诊断要点[J]. 实用心脑肺血管病杂志, 2021, 29(6): 134. |
[4] | Li, M., Cheng, K., Ku, K., et al. (2021) Factors Influencing the Length of Hospital Stay among Patients with Chronic Obstructive Pulmonary Disease (COPD) in Macao Population: A Retrospec-tive Study of Inpatient Health Record. International Journal of Chronic Obstructive Pulmonary Disease, 16, 1677-1685.
https://doi.org/10.2147/COPD.S307164 |
[5] | Maddocks, M., Kon, S.S.C., Singh, S.J., et al. (2015) Rehabilitation Following Hospitalization in Patients with COPD: Can It Reduce Readmissions? Respirology, 20, 395-404. https://doi.org/10.1111/resp.12454 |
[6] | Xu, J., Wang, X., Li, Z., et al. (2021) AECOPD Research in the Past Ten Years: A Bibliographic Analysis Based on Web of Science. Annals of Palliative Medicine, 10, 10401-10413. https://doi.org/10.21037/apm-21-2756 |
[7] | Kunadharaju, R. and Sethi, S. (2020) Treatment of Acute Exacerbations in Chronic Obstructive Pulmonary Disease. Clinics in Chest Medicine, 41, 439-451. https://doi.org/10.1016/j.ccm.2020.06.008 |
[8] | Choi, J., Shim, J.J., Lee, M.G., et al. (2023) Association between Air Pollution and Viral Infection in Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Journal of Korean Medical Science, 38, e68.
https://doi.org/10.3346/jkms.2023.38.e68 |
[9] | King, D.E., Xiang, J. and Pilkerton, C.S. (2018) Multimorbidity Trends in United States Adults, 1988-2014. The Journal of the American Board of Family Medicine, 31, 503-513. https://doi.org/10.3122/jabfm.2018.04.180008 |
[10] | Chen, T., Dredze, M., Weiner, J.P., et al. (2019) Identifying Vulnerable Older Adult Populations by Contextualizing Geriatric Syndrome Information in Clinical Notes of Electronic Health Records. Journal of the American Medical Informatics Association, 26, 787-795. https://doi.org/10.1093/jamia/ocz093 |
[11] | Masnoon, N., Shakib, S., Kalisch-Ellett, L., et al. (2017) What Is Polypharmacy? A Systematic Review of Definitions. BMC Geriatrics, 17, 230-239. https://doi.org/10.1186/s12877-017-0621-2 |
[12] | Ciabattini, A., Nardini, C., Santoro, F., et al. (2018) Vaccination in the Elderly: The Challenge of Immune Changes with Aging. Seminars in Immunology, 40, 83-94. https://doi.org/10.1016/j.smim.2018.10.010 |
[13] | Tan, D.B.A., Teo, T.H., Setiawan, A.M., et al. (2017) Increased CTLA-4+ T Cells May Contribute to Impaired T Helper Type 1 Immune Responses in Patients with Chronic Obstructive Pulmonary Disease. Immunology, 151, 219-226.
https://doi.org/10.1111/imm.12725 |
[14] | Cederholm, T., Bosaeus, I., Barazzoni, R., et al. (2015) Diagnostic Criteria for Malnutrition—An ESPEN Consensus Statement. Clinical Nutrition, 34, 335-340. https://doi.org/10.1016/j.clnu.2015.03.001 |
[15] | Hoong, J.M., Ferguson, M. and Hukins, C., et al. (2017) Economic and Operational Burden Associated with Malnutrition in Chronic Obstructive Pulmonary Disease. Clinical Nutrition, 36, 1105-1109.
https://doi.org/10.1016/j.clnu.2016.07.008 |
[16] | 李国翔, 赵京梅, 王永红. 营养状况与慢性阻塞性肺疾病急性加重的相关性研究[J]. 临床肺科杂志, 2017, 22(1): 73-76. |
[17] | Messous, S., Elargoubi, A., Pillet, S., et al. (2021) Bacterial and Viral Infection in Patients Hospitalized for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Implication for Antimicrobial Management and Clinical Outcome. Chronic Obstructive Pulmonary Disease, 18, 53-61. https://doi.org/10.1080/15412555.2020.1854210 |
[18] | Xiao, M., Wang, X., Wang, H., et al. (2023) Risk Factors for Hyponatremia in Acute Exacerbation Chronic Obstructive Pulmonary Disease (AECOPD): A Multicenter Cross-Sectional Study. BMC Pulmonary Medicine, 23, Article No. 39. https://doi.org/10.1186/s12890-023-02328-4 |
[19] | Wu, C.T., Li, G.H., Huang, C.T., et al. (2021) Acute Exacerba-tion of a Chronic Obstructive Pulmonary Disease Prediction System Using Wearable Device Data, Machine Learning, and Deep Learning: Development and Cohort Study. JMIR Mhealth Uhealth, 9, e22591. https://doi.org/10.2196/22591 |
[20] | Wang, H., Yang, T., Yu, X., et al. (2022) Risk Factors for Length of Hospital Stay in Acute Exacerbation Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study. International Journal of General Medicine, 15, 3447-3458. https://doi.org/10.2147/IJGM.S354748 |
[21] | Soriano, J.B. (2017) An Epidemiological Overview of Chronic Obstructive Pulmonary Disease: What Can Real-Life Data Tell Us about Disease Management? COPD, 14, S3-S7. https://doi.org/10.1080/15412555.2017.1286165 |
[22] | Miravitlles, M. and An-zueto, A. (2017) Chronic Respiratory Infection in Patients with Chronic Obstructive Pulmonary Disease: What Is the Role of Antibiotics? International Journal of Molecular Sciences, 18, Article No. 1344.
https://doi.org/10.3390/ijms18071344 |
[23] | Hsu, C., Suk, C., Hsu, Y., et al. (2022) Sphingosine-1-Phosphate and CRP as Potential Combination Biomarkers in Discrimination of COPD with Community-Acquired Pneumonia and Acute Exacerbation of COPD. Respiratory Research, 23, Article No. 63. https://doi.org/10.1186/s12931-022-01991-1 |
[24] | Mallia, P., Finney, L., Ritchie, A., et al. (2014) Lower Airway Colonization and Inflammatory Response in COPD: A Focus on Haemophilus Influenzae. International Journal of Chronic Obstructive Pulmonary Disease, 9, 1119-1132. |
[25] | Kuwal, A., Joshi, V., Dutt, N., et al. (2018) A Prospective Study of Bacteriological Etiology in Hospitalized Acute Exacerbation of COPD Patients: Relationship with Lung Func-tion and Respiratory Failure. Turkish Thoracic Journal, 19, 19-27. https://doi.org/10.5152/TurkThoracJ.2017.17035 |
[26] | Choi, J., Oh, J.Y., Lee, Y.S., et al. (2019) Bacterial and Vi-ral Identification Rate in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Korea. Yonsei Medical Jour-nal, 60, 216-222.
https://doi.org/10.3349/ymj.2019.60.2.216 |
[27] | Kano, K., Washio, Y., Fujimoto, T., et al. (2022) Differences in the Spectrum of Respiratory Viruses and Detection of Human Rhinovirus C in Exacerbations of Adult Asthma and Chronic Obstructive Pulmonary Disease. Respiratory Investigation, 60, 129-136. https://doi.org/10.1016/j.resinv.2021.08.009 |
[28] | Jahan, R., Mishra, B., Behera, B., et al. (2021) Study of Respira-tory Viruses and Their Coinfection with Bacterial and Fungal Pathogens in Acute Exacerbation of Chronic Obstructive Pulmonary Diseases. Lung India, 38, 53-58.
https://doi.org/10.4103/lungindia.lungindia_273_20 |
[29] | Song, W., Wang, Y., Tian, F., et al. (2021) Clinical Sig-nificance of Procalcitonin, C-Reactive Protein, and Interleukin-6 in Helping Guide the Antibiotic Use for Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Disease Markers, 2021, Article ID: 8879401. https://doi.org/10.1155/2021/8879401 |
[30] | Hosseini, S.S., Ghasemian, E., Jamaati, H., et al. (2015) Association between Respiratory Viruses and Exacerbation of COPD: A Case-Control Study. Infectious Diseases, 47, 523-529. https://doi.org/10.3109/23744235.2015.1022873 |
[31] | Yao, C., Wang, L., Shi, F., et al. (2021) Optimized Combi-nation of Circulating Biomarkers as Predictors of Prognosis in AECOPD Patients Complicated with Heart Failure. In-ternational Journal of Medical Sciences, 18, 1592-1599.
https://doi.org/10.7150/ijms.52405 |
[32] | Tong, X., Cheng, A., Xu, H., et al. (2018) Aspergillus Fumigatus during COPD Exacerbation: A Pair-Matched Retrospective Study. BMC Pulmonary Medicine, 18, Article No. 55. https://doi.org/10.1186/s12890-018-0611-y |
[33] | Feng, C., Xu, M., Kang, J., et al. (2021) Atypical Pathogen Dis-tribution in Chinese Hospitalized AECOPD Patients: A Multicenter Cross-Sectional Study. International Journal of Chronic Obstructive Pulmonary Disease, 16, 1699-1708.
https://doi.org/10.2147/COPD.S300779 |
[34] | Shukla, S.D., Mahmood, M.Q., Weston, S., et al. (2017) The Main Rhinovirus Respiratory Tract Adhesion Site (ICAM-1) Is Upregulated in Smokers and Patients with Chronic Airflow Limitation (CAL). Respiratory Research, 18, Article No. 6. https://doi.org/10.1186/s12931-016-0483-8 |
[35] | Loh, L.C., Rashid, A., Sholehah, S., et al. (2016) Low Prevalence of Obstructive Lung Disease in a Suburban Population of Malaysia: A BOLD Collaborative Study. Respirology, 21, 1055-1061. https://doi.org/10.1111/resp.12793 |
[36] | Li, J., Sun, S., Tang, R., et al. (2016) Major Air Pollutants and Risk of COPD Exacerbations: A Systematic Review and Meta-Analysis. The International Journal of Chronic Obstructive Pulmonary Disease, 11, 3079-3091.
https://doi.org/10.2147/COPD.S122282 |
[37] | Song, B., Zhang, H., Jiao, L., et al. (2022) Effect of High-Level Fine Particulate Matter and Its Interaction with Meteorological Factors on AECOPD in Shijiazhuang, China. Scientific Reports, 12, Article No. 8711.
https://doi.org/10.1038/s41598-022-12791-4 |
[38] | Zheng, B., Taljaard, M., Aaron, S.D., et al. (2022) Association between Antibiotics and Rehospitalization in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Dis-ease Discharged from the Emergency Department. Canadian Journal of Emergency Medicine, 24, 725-734. https://doi.org/10.1007/s43678-022-00373-2 |
[39] | Kwak, H.J., Park, D.W., Kim, J.E., et al. (2016) Prevalence and Risk Factors of Respiratory Viral Infections in Exacerbations of Chronic Obstructive Pulmonary Disease. The Tohoku Journal of Experimental Medicine, 240, 131-139.
https://doi.org/10.1620/tjem.240.131 |
[40] | Djamin, R.S., Uzun, S., Snelders, E., et al. (2015) Occurrence of Vi-rus-Induced COPD Exacerbations during Four Seasons. Infectious Diseases (London), 47, 96-100. https://doi.org/10.3109/00365548.2014.968866 |
[41] | Fu, X., Zhong, Y., Xu, W., et al. (2021) The Prevalence and Clinical Features of Pulmonary Embolism in Patients with AE-COPD: A Meta-Analysis and Systematic Review. PLOS ONE, 16, e0256480.
https://doi.org/10.1371/journal.pone.0256480 |
[42] | Y?lmaz, C., ?zkan, S. and Erer, O.F. (2021) Risk Assessment and Rate of Readmission within 30 Days of Discharge after Hospitalization for Acute Exacerbation of Chronic Obstruc-tive Pulmonary Disease. Tu?berku?loz ve Toraks, 69, 328-337. https://doi.org/10.5578/tt.20219705 |
[43] | Li, M., Cheng, K., Ku, K., et al. (2023) Modelling 30-Day Hospital Readmission after Discharge for COPD Patients Based on Electronic Health Records. NPJ Primary Care Respiratory Medicine, 33, Article No. 16.
https://doi.org/10.1038/s41533-023-00339-6 |
[44] | Cardoso, J., Coelho, R., Rocha, C., et al. (2018) Prediction of Severe Exacerbations and Mortality in COPD: The Role of Exacerbation History and Inspiratory Capacity/Total Lung Capacity Ratio. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1105-1113. https://doi.org/10.2147/COPD.S155848 |
[45] | Calverley, P.M., Tetzlaff, K., Dusser, D., et al. (2017) Determinants of Exacerbation Risk in Patients with COPD in the TIOSPIR Study. International Journal of Chronic Obstructive Pul-monary Disease, 12, 3391-3405.
https://doi.org/10.2147/COPD.S145814 |
[46] | Dixit, D., Bridgeman, M.B., Andrews, L.B., et al. (2015) Acute Ex-acerbations of Chronic Obstructive Pulmonary Disease: Diagnosis, Management, and Prevention in Critically Ill Patients. Pharmacotherapy, 35, 631-648.
https://doi.org/10.1002/phar.1599 |
[47] | Müllerová, H., Shukla, A., Hawkins, A., et al. (2014) Risk Factors for Acute Exacerbations of COPD in a Primary Care Population: A Retrospective Observational Cohort Study. BMJ Open, 4, e006171.
https://doi.org/10.1136/bmjopen-2014-006171 |
[48] | Au, L.H. and Chan, H.S. (2013) Severity of Airflow Limita-tion, Co-Morbidities and Management of Chronic Obstructive Pulmonary Disease Patients Acutely Admitted to Hospital. Hong Kong Medical Journal, 19, 498-503. |
[49] | Foda, H., Brehm, A., Goldsteen, K., et al. (2017) Inverse Relationship between Nonadherence to Original GOLD Treatment Guidelines and Exacerbations of COPD. International Journal of Chronic Obstructive Pulmonary Disease, 12, 209-214. https://doi.org/10.2147/COPD.S119507 |
[50] | Ma, X., Cui, J., Wang, J., et al. (2015) Multicentre Investigation of Pathogenic Bacteria and Antibiotic Resistance Genes in Chinese Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Journal of International Medical Research, 43, 699-710. https://doi.org/10.1177/0300060515587577 |
[51] | 张丽, 范忠杰, 周凡. 慢性阻塞性肺疾病急性加重期肺部感染患者的病原菌分布、耐药性及危险因素分析[J]. 中国病原生物学杂志, 2019, 14(12): 1456-1459. |
[52] | Diao, W.Q., Xu, M. and He, B. (2018) The Microbiome in Chronic Obstructive Pulmonary Disease. Chinese Journal of Tuberculosis and Respiratory Diseases, 41, 982-985. |
[53] | Brennan, M., McDonnell, M.J., Harri-son, M.J., et al. (2022) Antimicrobial Therapies for Prevention of Recurrent Acute Exacerbations of COPD (AECOPD): Beyond the Guidelines. Respiratory Research, 23, Article No. 58.
https://doi.org/10.1186/s12931-022-01947-5 |
[54] | Hoult, G., Gillespie, D., Wilkinson, T.M.A., et al. (2022) Bi-omarkers to Guide the Use of Antibiotics for Acute Exacerbations of COPD (AECOPD): A Systematic Review and Me-ta-Analysis. BMC Pulmonary Medicine, 22, Article No. 194.
https://doi.org/10.1186/s12890-022-01958-4 |
[55] | Bagge, K., Sivapalan, P., Ekl?f, J., et al. (2021) Antibiotic Treatment in Acute Exacerbation of COPD: Patient Outcomes with Amoxicillin vs. Amoxicillin/Clavulanic Acid—Data from 43,636 Outpatients. Respiratory Research, 22, Article No. 11. https://doi.org/10.1186/s12931-020-01606-7 |