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目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)并发侵袭性肺曲霉菌病(invasive pulmonary aspergillosis,IPA)的临床特征和危险因素。方法分析沧州市中心医院2015年12月至2016年12月收治的189例COPD患者的病历资料,将其中65例并发IPA的患者纳入观察组,124例未并发IPA的患者纳入对照组。分析两组患者的临床特征及COPD患者并发IPA的危险因素。结果观察组年龄≥60岁、呼吸困难、咯血、抗菌药物使用时间≥14天、机械通气、机械通气时间≥7天、C反应蛋白水平≥50 mg/L、球蛋白水平<20 g/L、动脉血氧分压<60 mm Hg及COPD分级为极重度的患者比例均显著高于对照组(P<0.05)。多因素Logistic回归分析显示,机械通气时间≥7天、COPD分级为极重度、抗菌药物使用时间≥14天是COPD并发IPA的主要危险因素(P<0.05)。结论 IPA是COPD患者病情危重的一项相关因素,机械通气时间≥7天、COPD分级为极重度、抗菌药物使用时间≥14天是COPD并发IPA的主要危险因素。
Objective To investigate the clinical characteristics and risk factors of invasive pulmonary aspergillosis (COPD) complicated with chronic obstructive pulmonary disease (IPD). Methods Clinical data of 189 patients with COPD admitted from December 2015 to December 2016 in Cangzhou Central Hospital were analyzed. Sixty-five patients with IPA were included in the observation group, and 124 patients without IPA were included in the control group. The clinical characteristics of two groups of patients and the risk factors of IPA complicated by COPD were analyzed. Results The observation group was aged 60 years or older with dyspnea, hemoptysis, antibacterial drug use for more than 14 days, mechanical ventilation, mechanical ventilation ≥7 days, C-reactive protein level ≥50 mg / L, globulin level <20 g / L, The proportion of patients with arterial oxygen pressure <60 mm Hg and patients with severe COPD was significantly higher than that of the control group (P <0.05). Multivariate Logistic regression analysis showed that the duration of mechanical ventilation was ≥7 days, and the grade of COPD was extremely severe. The duration of antimicrobial use ≥14 days was the main risk factor of COPD with IPA (P <0.05). Conclusions IPA is a risk factor for COPD patients. The duration of mechanical ventilation is ≥7 days, the severity of COPD is very severe, and the duration of antimicrobial use is ≥14 days. The main risk factors for COPD with IPA are IPA.