糖尿病患者肺部感染特征及危险因素分析

Clinical characteristics and risk factors of diabetes mellitus complicated with pulmonary infection

目的 分析糖尿病合并肺部感染患者的临床特征及引发感染的危险因素。方法 回顾性分析2020-2021年于南阳医学高等专科学校第一附属医院接受治疗的糖尿病合并肺部感染38例患者的临床资料,采集其痰液标本进行培养及病原菌鉴定。对分离到的肺炎克雷伯菌,采用PCR技术检测其携带rmpA、ureA、fimH、wabG、magA和ybtA六种毒力基因的情况。随机选取同期肺部未发生感染的单纯糖尿病患者30例作为对照组,对比两组患者的临床资料,分析糖尿病合并肺部感染的危险因素。结果 38例糖尿病合并肺部感染患者的临床特征主要为咳痰、咳嗽、呼吸困难、食欲减退,肺部感染以大叶肺炎与小叶肺炎为主。共培养分离出42株病原菌,患者以单一病原菌感染为主。革兰阴性菌25株,占59.52%,以肺炎克雷伯菌(15株)为主;革兰阳性菌14株,占33.33%,以肺炎链球菌(6株)为主;真菌3株,包括2株烟曲霉菌与1株白色念珠菌。对比分析感染组与非感染组临床资料,结果显示,感染组患者年龄高、糖尿病病程长、住院时间长、有侵入性操作史患者占比高、肺通气功能差、抗菌药物使用时间长、低蛋白血症发生率高、糖化血红蛋白(HbA1c)值与空腹血糖(FPG)较高(P<0.05)。经多因素回归分析发现,有侵入性操作、低蛋白血症、糖化血红蛋白(HbA1c)值(%)≥7、空腹血糖(FPG)(mmol/L)≥8.0是糖尿病合并肺部感染的独立危险因素(P<0.05)。15株菌株全部携带ureA,wabG、fimH、ybtA的携带率高于50%,其中有5株携带4种毒力基因,2株携带6种毒力基因。结论 糖尿病合并肺部感染患者,肺部容易并发大叶肺炎,以肺炎克雷伯菌为主的革兰阴性菌是主要致病菌,引发糖尿病患者并发肺部感染的危险因素主要为侵入性操作、低蛋白血症、糖化血红蛋白值及空腹血糖高。

Objective The clinical characteristics and risk factors of pulmonary infection in patients with diabetes mellitus were analyzed. Methods The clinical data of 38 patients with diabetes mellitus complicated with pulmonary infection who were treated in the First Affiliated Hospital of Nanyang Medical College from 2020 to 2021 were analyzed retrospectively. Their sputum samples were collected for culture and pathogen identification. Six virulence genes, rmpA,ureA,fimH,wabG,magA and ybtA in the isolated Klebsiella pneumoniae,were detected by PCR. Randomly select 30 simple diabetic patients without pulmonary infection in the same period as the control group, compare the clinical data of the two groups of patients, and analyze the risk factors of diabetes mellitus with pulmonary infection. Results The clinical features of 38 patients with diabetes mellitus complicated with pulmonary infection were mainly expectoration, cough, dyspnea and anorexia. The pulmonary infection was mainly lobar pneumonia and lobular pneumonia. 42 strains of pathogenic bacteria were isolated by co culture. The patients were mainly infected by single pathogen. 59.52% were gram negative bacteria, mainly K. pneumoniae(15 strains). 33.33% were gram-positive bacteria, mainly Streptococcus pneumoniae(6 strains). There are 3 fungi in total, including 2 Aspergillus fumigatus and 1 Candida albicans. The clinical data of the infection group and the non infection group were compared and analyzed. The results showed that the patients in the infection group were old, long course of diabetes, long hospital stay, high proportion of patients with invasive operation history, poor pulmonary ventilation function, long use of antibacterial drugs, high incidence of hypoproteinemia, and high HbA1c values and fasting plasma glucose(FPG)(P<0.05). Multivariate regression analysis showed that invasive operation, hypoproteinemia, HbA1c value(%)≥7,and fasting plasma glucose(FPG)≥8.0 were independent risk factors for diabetes mellitus with pulmonary infection(P<0.05). All 15 strains carried ureA,and the carrying rate of wabG,fimH and ybtA was higher than 50%. Among them, 5 strains carried 4 virulence genes, and 2 strains carried 6 virulence genes. Conclusion In patients with diabetes mellitus complicated with pulmonary infection, the lung was prone to complicated lobar pneumonia. Gram negative bacteria, mainly K. pneumoniae,were the main pathogens. The risk factors for diabetes mellitus patients complicated with pulmonary infection were mainly invasive operation, hypoproteinemia, glycosylated hemoglobin value and high fasting blood glucose.