不同气候条件下慢性阻塞性肺疾病的病原学和免疫学研究

目的：探讨COPD患者不同气候条件下（雷暴、阴雨、台风）的病原学和免疫功能。方法：细菌鉴定采用VITEK全自动微生物鉴定系统。K．B纸片扩散法测定药敏。T淋巴细胞亚群测定采用单克隆抗体免疫组化荧光染色法。血清免疫球蛋白（IgG，IgA，IgM）用琼脂单向扩散法。结果：台风、雷暴、阴雨、天气气候条件60例患者痰培养阳性率分别为45％、40％、30％，占革兰阴性菌前2位分别为肺炎克雷伯杆菌、流感嗜血杆菌和肺炎克雷伯杆菌、大肠埃希杆菌及流感嗜血杆菌、铜绿假单胞菌。革兰阳性菌中分别以肺炎链球菌、金黄色葡萄球菌为主及肺炎链球菌、金黄色葡萄球菌为主和金黄色葡萄球菌、表皮葡萄球菌为主。铜绿假单胞菌、肺炎克雷伯杆菌、流感嗜血杆菌对常用抗生素具有较高的耐药性。台风、雷暴、阴雨气候条件下3组AECOPD患者CD3＋ CD4＋、CD4＋／CD8＋、IgG、IgA、IgM均明显低于健康对照组（P〈0．05），CD8＋高于健康对照组（P〈0．05），而发作期和缓解期无显著差异（P〉0．05）。三种气候条件下相互之间比较的细胞和体液免疫指标比较无显著差剐（P〉0．05）。结论：雷暴、阴雨、台风条件下AECOPD的患者存在病原学分布差异，对常用抗生素具有较高的耐药性，细胞和体液免疫功能进一步下降。但三者相互之间的免疫功能比较无明显差异。

Etiology and Immunology in Chronic Obstructive Pulmonary Disease under Different Climatic Conditions

Objective： To explore the etiology and immune function of COPD patients under different climatic conditions （thunderstorms, rainy, typhoons）. Methods： Bacteria were identified by VITEK automated microbial identification system. The drug sensitivity was examined by Kribry-Bauer （K-B）paper. The T lymphocyte subgroup determination used the monoclonal antibody immunity group fluorescence dyeing. Agar unidirectional diffusion process was applied to detect the seroimmunity globulin （IgG, IgA, IgM）. Results： The positive rates of sputum culture were 45%, 40%, 30%, respectively in Typhoons, thunderstorms, and rainy conditions. The first two Gram-negative bacteria were Klebsiella pneumonia and Haemophilus influenza under Typhoons condition; Klebsiella pneumonia and Escherichia coli under thunderstorms; and Haemophilus influenza and Pseudomonas aeruginosa. Gram-positive bacteria were primarily Streptococcus pneumonia and Staphylococcus aureus in Typhoons, and Streptococcus pneumonia and Staphylococcus aureus in thunderstorms; and Staphylococcus aureus and Staphylococcus epidermidis in rain. Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenza had high resistance to commonly used antibiotics. Under the three weather conditions, among, the levels of CD3＋, CD4＋, CD4＋/CD8＋ , IgG, IgA, and IgM were obviously lower in the three groups of AECOPD patients than in control group （P〈0.05）; but that of CD8＋ was higher than control group （P〈0.05）; however, compared with episode and remission, there was no significant difference between the groups （P〉0.05）. The cells and humoral immune index comparison between three kinds of climate conditions showed no statistically significant difference （P〉0.05）. Conclusion： Under the three kinds of climatic conditions （thunderstorms, rainy, typhoons）, AECOPD patients have difference in etiology distribution, high resistance to commonly used antibiotics, and decline of the cellular and humoral immunity function. However, there was no statistically significant difference in cells and humoral immune index between them.