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目的了解慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease COPD)急性发作期继发真菌感染的发病率、病死率、临床表现、辅助检查及其发病相关因素,为临床诊治、预防提供有利依据。方法对2008年3月至2011年2月入住我院呼吸内科且符合COPD急性发作期诊断的500例患者进行回顾性分析,对真菌感染组和非真菌感染组进行病例对照研究,从而分析真菌感染组的临床特点、相关因素、病原学分布等。结果 500例患者中继发真菌感染53例。针对真菌感染的危险因素进行单因素分析,发现年龄、住院时间、血浆白蛋白、激素疗程、抗生素种类和疗程、侵袭性诊疗操作均为继发真菌感染的相关危险因素。把相关危险因素引入Logistic回归分析发现住院时间长、激素和抗生素疗程长、低蛋白血症、存在侵袭性诊疗操作为主要相关因素。结论对于老年、住院时间长、存在侵袭性诊疗操作、低蛋白血症、长期广谱高效抗生素和糖皮质激素的应用的COPD急性发作期的患者,应该警惕继发真菌感染。
Objective To investigate the incidence, mortality, clinical manifestation, auxiliary examination and related factors of secondary fungal infections in acute episode of chronic obstructive pulmonary disease (COPD), and to provide a favorable basis for clinical diagnosis and treatment. Methods From March 2008 to February 2011 admitted to our hospital respiratory medicine and consistent with acute exacerbation of COPD were retrospectively analyzed 500 cases of fungal infection and non-fungal infection group case-control study to analyze fungal infections Group of clinical features, related factors, such as etiological distribution. Results 500 cases of secondary fungal infection in 53 cases. Univariate analysis of the risk factors for fungal infection found that age, hospital stay, serum albumin, hormone therapy, antibiotic classes and courses of treatment, invasive treatment are secondary risk factors associated with fungal infection. The introduction of relevant risk factors into Logistic regression analysis found that hospitalization for a long time, long course of hormone and antibiotic therapy, hypoproteinemia, the existence of invasive diagnosis and treatment operations as the main relevant factors. Conclusions Patients with acute exacerbation of COPD who are elderly, have long hospital stays, have invasive procedures, hypoproteinemia, long-term use of broad-spectrum antibiotics and glucocorticoids should be wary of secondary fungal infections.