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目的探讨老年慢性阻塞性肺疾病(COPD)患者院内肺部真菌感染的可能易患因素、感染时间、临床特征、感染常见真菌与预后。方法回顾性分析36例65岁以上COPD院内肺部真菌感染患者与同期40例65岁以上COPD院内肺部非真菌感染患者的临床资料。结果老年COPD患者院内肺部真菌感染的可能易患因素与长期使用广谱抗生素、糖皮质激素,低蛋白血症、粒细胞减少相关;吸烟时间较长及每年住院次数增多也是老年COPD患者发生院内肺部真菌感染的可能易感因素;约1/3患者肺部真菌发生在入院1～2周,临床特征无特异性;病原菌主要为白色念珠菌(80.55%),胸部X线表现以支气管肺炎及团块影改变为主,预后较差。结论老年COPD患者若长期使用广谱抗生素和(或)糖皮质激素,有低蛋白血症或粒细胞减少,可能会并发院内肺部真菌感染,预后较差,长期吸烟及多次住院患者也应提高警惕,重视可能易患因素并尽早采取预防与治疗措施,减少死亡的发生。
Objective To explore the possible predisposing factors, infection time, clinical features, common fungi and prognosis of pulmonary fungal infection in elderly patients with chronic obstructive pulmonary disease (COPD). Methods The clinical data of 36 patients with pulmonary fungal infection in hospital aged over 65 years and 40 patients with pulmonary non-mycotic infection in COPD hospital over 65 years old in the same period were retrospectively analyzed. Results The elderly susceptible COPD patients with pulmonary fungal infection risk factors and long-term use of broad-spectrum antibiotics, glucocorticoids, hypoproteinemia, neutropenia related; smoking a long time and increase the number of annual hospitalizations are also elderly patients with COPD About 1/3 of patients with pulmonary fungi in hospital for 1 to 2 weeks, no specific clinical features; pathogen mainly Candida albicans (80.55%), chest X ray showed bronchopneumonia And clumps of film change-based, poor prognosis. Conclusion Long-term use of broad-spectrum antibiotics and / or glucocorticoids in elderly COPD patients with hypoalbuminemia or neutropenia may lead to pulmonary fungal infections in the hospital with poor prognosis, long-term smoking and multiple hospitalizations Increase vigilance, attach importance to possible predisposing factors and take early preventive and curative measures to reduce the incidence of death.