老年慢性阻塞性肺疾病继发肺真菌病的危险因素研究

Risk factors for secondary pulmonary fungal infection in elderly patients with chronic obstructive pulmonary disease

摘要:

目的探讨慢性阻塞性肺疾病（COPD）患者继发医院肺部真菌感染的危险因素。方法采用病例对照研究方法，回顾性分析52例COPD继发肺部真菌感染患者的临床资料，并随机选择同期住院的未继发肺部真菌感染的52例COPD患者作为对照，分析其危险因素。结果52例医院肺部真菌感染患者感染菌种包括：白假丝酵母菌40例(76.92%)，光滑假丝酵母菌3例(5.77%)，热带假丝酵母菌7例(13.46%)，毛霉菌属及曲霉菌属各1例(1.92%)。单因素分析结果显示，广谱抗菌药物使用时间＞14 d、累计全身使用肾上腺糖皮质激素＞500 mg、低蛋白血症、Ⅱ型呼吸衰竭、机械通气及合并糖尿病与COPD患者发生医院肺部真菌感染有关。多因素Logistic回归分析结果显示，累计全身使用肾上腺糖皮质激素＞500 mg、广谱抗菌药物使用时间＞14 d、机械通气、合并Ⅱ型呼吸衰竭是COPD患者继发医院肺部真菌感染的重要危险因素。结论了解COPD继发医院肺部真菌感染的危险因素，有助于针对性地采取防控措施，减少深部真菌感染的发生。

Abstract:

ObjectiveTo evaluate the risk factors for secondary pulmonary fungal infection in patients with chronic obstructive pulmonary disease (COPD).MethodsClinical data of 52 cases of secondary pulmonary fungal infection associated with COPD were analyzed retrospectively through casecontrol study , 52 cases of COPD patients without secondary pulmonary fungal infection were randomly selected as control, and risk factors were analyzed．ResultsFungi which isolated from 52 infected patients included Candida albicans(40 cases, 76.92%), Candida glabrata(3 cases, 5.77%), Candida tropicalis(7 cases, 13.46%), Mucor(1 case， 1.92%), and Aspergillus(1 case， 1.92%) . Univariate analysis showed that the factors associated with secondary pulmonary fungal infection included duration of broadspectrum antimicrobial use>14 d, cumulative amount of systemic glucocorticoid use >500 mg, hypoalbuminemia, typeⅡrespiratory failure, mechanical ventilation and diabetes mellitus. Multivariate Logistic regression analysis showed that cumulative amount of systemic glucocorticoid use >500 mg, duration of broadspectrum antimicrobial use >14 d, mechanical ventilation and typeⅡrespiratory failure were high risk factors for secondary pulmonary fungal infection in patients with COPD.ConclusionThe knowledge of the risk factors for secondary pulmonary fungal infection associated with COPD can promote to take proper preventive measures, and reduce the occurrence of deep fungal infection .