分析慢性阻塞性肺疾病（COPD）合并肺部感染者病原菌分布以及相关血清细胞因子水平对患者临床转归的影响。

选取2015年2月至2017年2月长治医学院附属和济医院收治的178例COPD合并肺部感染者作为研究对象；采用呼吸道9项病毒荧光标记PCR进行病毒鉴定；采用BD BACTEC^? FX40全自动细菌鉴定仪鉴定细菌种类；采用酶联免疫吸附法（ELISA）检测血清白细胞介素（IL-6、IL-10）、干扰素（IFN-α、IFN-γ）和肿瘤坏死因子（TNF-α、TNF-β）水平；并分析以上指标对COPD合并肺部感染者临床转归的影响。

178例入组患者根据感染病原体不同分为病毒感染组36例（20.22%）和细菌感染组（142例），其中细菌感染组患者中革兰阳性菌感染者47例（26.41%），革兰阴性菌感染者95例（53.37%）。细菌感染组患者血清IL-6、IL-10、IFN-α、IFN-γ、TNF-α和TNF-β水平均显著高于病毒感染组，差异均有统计学意义（P均< 0.001）。178例患者中住院天数≥ 7 d者和死亡者IL-6、IL-10、IFN-α、IFN-γ、TNF-α和TNF-β水平分别显著高于住院天数< 7 d者和生存者，差异均有统计学意义（P均< 0.001）。Logistic回归分析显示，高龄、阻塞性肺疾病全球倡议（GOLD）分级（3/4）、革兰阴性菌感染和高水平IL-6均为患者短期临床转归的重要影响因素（P = 0.01、0.01、0.04、0.03）；而高龄、GOLD分级（3/4）、吸烟史、住院天数≥ 7 d和第1秒用力呼气量（FEV1）（%预测值）则均为患者长期临床转归的重要影响因素（P均< 0.05）。

COPD合并肺部感染以革兰阴性菌感染最多见，因病原菌种类不同，IL、IFN和TNF等细胞因子水平差异较大，其中IL-6对患者短期临床转归影响较为显著。

To investigate the distribution of pathogenic bacteria in patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary infection, and to analyze the effect of related serum cytokine levels on the clinical outcome of patients.

From February 2015 to February 2017, a total of 178 patients with COPD complicated with pulmonary infection were treated in Heji Hospital Affiliated to Changzhi Medical College. Virus identification was done by nine respiratory tract viruses fluorescent labeling PCR. The species of bacteria were identified by BD BACTEC^? FX40 automatic bacterial identification instrument. Serum interleukin (IL-6 and IL-10), interferon (IFN-α and IFN-γ) and tumor necrosis factor (TNF-α and TNF-β) were detected by enzyme linked immunosorbent assay (ELISA); while the effect of the above indexes on the clinical outcome of COPD patients complicated with pulmonary infection were analyzed, respectively.

Total of 178 patients with COPD were divided into virus infection group (36 cases, 20.22%) and bacterial infection group (142 cases) according to the detected pathogen. Among the 142 cases with bacterial infection, 47 (26.41%) patients were with Gram-positive bacteria infection and 95 (53.37%) with Gram-negative bacteria infection. The levels of serum IL-6, IL-10, IFN-α, IFN-γ, TNF-α and TNF-β in bacterial infection group were significantly higher than those of virus infection group, all with significant differences (all P < 0.001). The levels of IL-6, IL-10, IFN-α, IFN-γ, TNF-α and TNF-β of patients with hospitalization days ≥ 7 days and the died cases were significantly higher than those with hospitalization days < 7 days and the survivors, respectively, all with significant differences (all P < 0.001). The results of Logistic regression analysis showed that elderly, Global Initiative for chronic obstructive lung disease (GOLD) grade (3/4), Gram-negative bacterial infection and high level of IL-6 were all important factors affecting the short-term clinical outcome of patients (P = 0.01, 0.01, 0.04 and 0.03). And elderly, GOLD grade (3/4), smoking history, hospitalization days ≥ 7 d, forced expiratory volume in the first second (FEV1) (% predictive value) were important factors for the long-term clinical outcome of the patients (all P < 0.05).

Gram-negative bacteria infection is most common among patients with COPD complicated with pulmonary infection. COPD and complicated with pulmonary infection is the most common infection of Gram-negative bacteria. Due to the different kinds of pathogenic bacteria, the levels of cytokines such as IL, IFN and TNF vary greatly; among whom, IL-6 has a significant effect on the short-term clinical outcome of patients.