肺癌患者伴肺炎的病原学与临床研究

Bacteriology of Pneumonia in Patients with Lung Cancer and Its Clinical Significance

目的探讨肺癌伴肺炎时的相关因素和病原学特点及意义。方法对2002-2005年肺癌伴肺炎患者病原学和临床特征进行回顾性研究。结果328例肺癌患者伴发肺炎176例(53.6%),年龄≥60岁和接受化疗的患者肺炎发生率较高,小细胞肺癌(63.0%)、鳞癌(59.7%)感染发生率高于腺癌(44.0%)和肺泡细胞癌(40.6%)(P<0.05);早期肺癌感染发生率(Ⅰ期7.7%,Ⅱ期10.8%)明显低于晚期肺癌(Ⅲ期56.1%,Ⅳ64.6%)(P<0.05);分离病原菌152株,革兰阴性菌占64.5%,肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、不动杆菌属居前5位;真菌占9.2%;肺炎克雷伯菌、铜绿假单胞菌、不动杆菌属、金黄色葡萄球菌出现高比例、多药耐药。结论肺癌伴肺炎与患者年龄、化疗以及肺癌的组织类型、临床分期密切相关,病原菌以革兰阴性杆菌为主,且存在多药耐药;应根据药敏结果选择抗菌药物,同时加强支持和综合治疗。

OBJECTIVE To study the bacteriology of pneumonia and its clinical significance in patients with lung cancer. METHODS The bacteriology and clinical features of patients with lung cancer accompanied with lung infections between 2002 and 2005 in our hospital were analyzed. RESULTS Pneumonia took place in 53.7% of 328 patients with lung cancer, the most of them were elderly people and the chemotherapy receivers, and the rates of pneumonia associated with small cell lung carcinoma （63%） and squamous cell carcinoma （59. 7%） were significantly higher than those with adenocarcinoma （44.0%） and alveolar cell carcinoma（40.6%） （P〈0.05）. Advanced stage of lung cancer was associated with higher infectious rates （stage Ⅰ ：7.7%; stage Ⅱ ：10. 8%% stage Ⅲ ：56.1% ; and stage Ⅳ ：64. 6%）（P〈0.05）. Totally 152 strains, the most （64.5%） of which were Gramnegative bacilli, were isolated from sputum specimens of 176 patients with lung cancer, The 5 most commonly isolated bacteria were Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter spp, Staphylococcus aureus and Acinetobacter, Except that all the Staphylococcus spp were sensitive to vancomycin, all the other strains showed resistance to all the agents tested in different levels, multidrug resistance occurred, CONCLUSIONS Pneumonia in patients with lung cancer is associated with age, chemotherapy, stages and histologic types of the tumor, In therapy, sensitive antibiotics should be selected based on the drug sensitivity tests combined with synthetical treatment.