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目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者肺部真菌感染的影响因素。方法选取2011年5月—2013年7月新疆医科大学第六附属医院收治的AECOPD继发肺部真菌感染患者73例作为试验组,另选择同期收治的AECOPD未继发肺部真菌感染患者80例作为对照组。比较两组患者临床资料,AECOPD患者肺部真菌感染的影响因素分析采用多因素Logistic回归分析。结果本组73例继发肺部真菌感染患者共培养出真菌115株,其中白假丝酵母菌63株,占54.78%;其他假丝酵母菌31株,占26.96%;曲霉菌21株,占18.26%。两组患者性别和肾功能不全发生率比较,差异均无统计学意义(P>0.05);试验组患者年龄大于对照组,肺源性心脏病、糖尿病、呼吸衰竭发生率及行机械通气者所占比例高于对照组,抗生素使用时间、激素使用时间及入住ICU时间长于对照组,清蛋白水平低于对照组(P<0.05)。多因素Logistic回归分析结果显示,年龄[OR=1.036,95%CI(1.021,1.050)]、肺源性心脏病[OR=1.096,95%CI(1.079,1.114)]、糖尿病[OR=3.177,95%CI(2.340,6.437)]、呼吸衰竭[OR=1.070,95%CI(1.040,1.102)]、抗生素使用时间[OR=4.059,95%CI(2.273,7.250)]、激素使用时间[OR=3.725,95%CI(2.061,6.733)]、入住ICU时间[OR=1.040,95%CI(1.020,1.059)]及机械通气[OR=3.380,95%CI(1.878,6.086)]是AECOPD患者肺部真菌感染的危险因素,清蛋白水平[OR=0.903,95%CI(0.868,0.939)]是AECOPD患者肺部真菌感染的保护因素(P<0.05)。结论 AECOPD患者肺部真菌感染的主要致病菌是白假丝酵母菌,且年龄、肺源性心脏病、糖尿病、呼吸衰竭、抗生素使用时间、激素使用时间、入住ICU时间、机械通气及清蛋白水平是AECOPD患者继发肺部真菌感染的影响因素,应引起临床重视。
Objective To analyze the influential factors of pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods From May 2011 to July 2013, 73 patients with secondary fungal infection of the lung in AECOPD admitted to the Sixth Affiliated Hospital of Xinjiang Medical University were enrolled as experimental group. Another 80 patients with non-secondary pulmonary fungal infection were enrolled in this study. As a control group. The clinical data of two groups were compared. The influencing factors of pulmonary fungal infection in AECOPD patients were analyzed by multivariate logistic regression analysis. Results A total of 115 strains of fungi were isolated from 73 patients with secondary pulmonary fungal infection, of which 63 were Candida albicans (54.78%), 31 (26.96%) were Candida albicans, 21 were Aspergillus 18.26%. There were no significant differences in the incidence of gender and renal dysfunction between the two groups (P> 0.05). The age of the patients in the experimental group was significantly higher than that in the control group. The incidence of pulmonary heart disease, diabetes, respiratory failure and the incidence of mechanical ventilation The proportion of antibiotics was higher than that of the control group (P <0.05). The antibiotic use time, hormone use time and ICU stay were longer than those of the control group. Multivariate Logistic regression analysis showed that age (OR = 1.036,95% CI 1.021,1.050), pulmonary heart disease (OR = 1.096,95% CI 1.079,1.114), diabetes (OR = 3.177, 95% CI (2.340,6.437)], respiratory failure [OR = 1.070,95% CI 1.040,1.102], duration of antibiotic use [OR = 4.059,95% CI 2.273,7.250] (OR = 1.040, 95% CI 1.020, 1.059) and mechanical ventilation (OR = 3.380, 95% CI 1.878, 6.086) were among patients with AECOPD Pulmonary fungal infection risk factors, albumin level [OR = 0.903,95% CI (0.868,0.939]] is a protective factor of pulmonary fungal infection in patients with AECOPD (P <0.05). Conclusions The main pathogen of pulmonary fungal infection in patients with AECOPD is Candida albicans, and age, pulmonary heart disease, diabetes, respiratory failure, antibiotic use time, hormone use time, ICU stay, mechanical ventilation and albumin The level of AECOPD secondary pulmonary fungal infection in patients with factors that should cause clinical attention.