免疫抑制剂联合甲氨喋呤对类风湿关节炎患者治疗后肺部真菌感染的危险因素分析

Analysis on the risk factors of pulmonary fungal infection after treatment of immune inhibitor combined with methotrexate in the patients with rheumatoid arthritis

目的:分析类风湿关节炎(RA)患者应用免疫抑制剂联合甲氨喋呤治疗后肺部真菌感染的危险因素,为感染性疾病的预防和控制提供客观依据。方法:选取2014年1月~2017年12月的128例应用免疫抑制剂联合甲氨喋呤治疗RA患者作为研究对象,对患者治疗期间的肺部真菌感染情况、病原菌分布进行观察和分析;对发生感染和未发生感染患者的临床资料进行对比,分析与感染相关的危险因素。结果:15例患者发生肺部真菌感染,感染率为11.72%,在感染患者呼吸道分泌物样本中检出病原菌29株,其中,曲霉菌属19株占65.52%,白色假丝酵母菌5株占17.24%,新型隐球酵母菌2株占6.9%。单因素分析结果显示,年龄较大、合并间质性肺炎、应用糖皮质激素、应用抗菌药物、疾病活动程度指数评分较高的患者的肺部真菌感染率较高。Logistic多元回归分析结果显示,RA患者应用免疫抑制剂联合甲氨喋呤治疗后肺部真菌感染的发生与合并间质性肺炎、应用糖皮质激素、应用抗菌药物具有相关性。结论:RA患者应用免疫抑制剂联合甲氨喋呤治疗后肺部真菌感染的发生与合并间质性肺炎及糖皮质激素、抗菌药物的应用有关,临床医生应给予高度的重视和有效的干预,以降低感染率、改善患者的预后。

Objective To analyze the risk factors of pulmonary fungal infection after treatment of immune inhibitor combined with methotrexate in the patients with rheumatoid arthritis(RA)to provide an objective basis for the prevention and control of infectious diseases.Methods 128 cases of RA patients treated with immune inhibitor combined with methotrexate from January of 2014 to December of 2017 were selected as the research subjects.The pulmonary fungal infections and the distribution of pathogenc bacteria during the treatment were observed and analyzed.The clinical data of the infected patients and the patients without infections were compared and analyzed and the risk factors related with infections were analyzed.Results 15 cases were with the pulmonary fungal infections,the infection rate was 11.72%.29 strains of pathogenic bacteria were detected in the respiratory exudates of the infected patients,among them,19 strains were Aspergillus accounting for 65.52%,5 strains were Candida albicans accounting for 17.24%,2 strains were Cryptococcus accounting for 6.9%.The results of single factor analysis showed that the rates of pulmonary fungal infections of the patients with older age,complication of interstitial pneumonia,application of glucocorticoid,application of antibiotics and higher disease activity index scores were higher.The results of Logistic multivariate regression analysis showed that the occurrence of pulmonary fungal infection in RA patients treated with immune inhibitor combined with methotrexate was correlated with the combination of interstitial pneumonia,the application of glucocorticoids,and the application of antibiotics.Conclusion The occurrence of pulmonary fungal infection in RA patients treated with immune inhibitor combined with methotrexate is correlated with the combination of interstitial pneumonia,the application of glucocorticoids,and the application of antibiotics.The clinicians should give high attention and effective intervention to reduce the infection rate and improve the prognosis of the patients with RA.