Pneumonic vs nonpneumonic acute exacerbations of COPD.
Pneumonic vs nonpneumonic acute exacerbations of COPD.
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COPD的肺炎与非脑急性加重。
DOI：
10.1378/chest.122.4.1264
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发表时间：
2002-10
期刊：
影响因子：
9.6
通讯作者：
Friedman MG
中科院分区：
文献类型：
--
作者：
Lieberman D;Lieberman D;Gelfer Y;Varshavsky R;Dvoskin B;Leinonen M;Friedman MG
描述并比较COPD肺炎性急性加重（PNAE）与非肺炎性急性加重（NPAE）的背景、临床表现、病程和感染病因。一项前瞻性观察性研究。以色列南部的一所高等院校医学中心。本研究纳入了23例PNAE住院患者和217例NPAE住院患者。对每一次住院患者的血清进行配对，并对12种病原体进行血清学检测。只有抗体滴度或水平的显著变化才被认为是诊断性的。两组之间与COPD或合并症相关的任何参数均无显著差异。两组间急性加重的临床类型无显著差异。与NPAE相比，PNAE患者入院时的Po 2值较低（p = 0.004），但突发（p = 0.005）、ICU入院（p = 0.006）、有创机械通气（p = 0.01）、死亡率（p = 0.007）和住院时间较长（p = 0.001）的发生率较高。在22例PNAE住院（96%）和153例NPAE住院（71%）中，至少确定了一种感染性病因（p = 0.001）。在13例PNAE患者（59%）和59例NPAE患者（39%;无显著性[NS]）中发现混合感染。在18例PNAE患者（78%）和99例NPAE患者（46%; p = 0.003）中确定了病毒病因。在10例PNAE患者（43%）和38例NPAE患者（18%; p = 0.006）中发现肺炎球菌病因。在8例PNAE患者（35%）和64例NPAE患者（30%; NS）中确定了非典型病因。社区获得性肺炎在因COPD急性加重而住院的患者中很常见，通常表现为更严重的临床和实验室参数。在PNAE中，与NPAE相比，病毒和肺炎球菌病因更常见，但非典型病原体的比例相似。这些发现的治疗意义应进一步研究。
To describe and compare the background, clinical manifestations, disease course, and infectious etiologies of pneumonic acute exacerbations (PNAE) vs nonpneumonic acute exacerbations (NPAE) of COPD. A prospective, observational study. A tertiary university medical center in southern Israel. Twenty-three hospitalizations for PNAE and 217 hospitalizations for NPAE were included in the study. Paired sera were obtained for each of the hospitalizations and were tested serologically for 12 pathogens. Only a significant change in antibody titers or levels was considered diagnostic. No significant differences were found between the two groups for any of the parameters related to COPD or comorbidity. The clinical type of the exacerbation was not significantly different between the groups. Compared to NPAE, patients with PNAE had lower Po2 values at hospital admission (p = 0.004) but higher rates of abrupt onset (p = 0.005), ICU admissions (p = 0.006), invasive mechanical ventilation (p = 0.01), mortality (p = 0.007), and longer hospital stay (p = 0.001). In 22 PNAE hospitalizations (96%) and in 153 NPAE hospitalizations (71%), at least one infectious etiology was identified (p = 0.001). Mixed infection was found in 13 patients with PNAE (59%) and in 59 patients with NPAE (39%; not significant [NS]). Viral etiology was identified in 18 patients with PNAE (78%) compared with 99 patients with NPAE (46%; p = 0.003). Pneumococcal etiology was found in 10 patients with PNAE (43%) and in 38 patients with NPAE (18%; p = 0.006). An atypical etiology was identified in 8 patients with PNAE (35%) and 64 patients with NPAE (30%; NS). Community-acquired pneumonia is common among patients hospitalized for an acute exacerbation of COPD and is generally manifested by more severe clinical and laboratory parameters. In PNAE, compared to NPAE, viral and pneumococcal etiologies are more common, but the rate of atypical pathogens is similar. The therapeutic significance of these findings should be investigated further.
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影响因子：
10
作者：
Lieberman, D;Schlaeffer, F;Porath, A
通讯作者：
Porath, A
DOI：
10.1164/ajrccm.154.5.8912764
发表时间：
1996-11-01
影响因子：
24.7
作者：
Torres, A;Dorca, J;Serra, J
通讯作者：
Serra, J
DOI：
10.1164/ajrccm.154.4.8887592
发表时间：
1996-10-01
影响因子：
24.7
作者：
Connors, AF;Dawson, NV;Knaus, WA
通讯作者：
Knaus, WA
影响因子：
24.3
作者：
Smith, JA;Redman, P;Woodhead, MA
通讯作者：
Woodhead, MA
影响因子：
4.2
作者：
VonHertzen, L;Alakarppa, H;Saikku, P
通讯作者：
Saikku, P