继发性免疫抑制患者肺部感染病原及死亡相关因素分析

Analysis of etiological agents and death relating factors of pulmonary infections in immunocompromised patients

目的探讨继发性免疫抑制患者（ＩＣＨ）肺部感染的病原体分布及影响预后的相关因素。方法对１９８６年１２月～１９９６年１２月期间经病原学和（或）病理学确诊的ＩＣＨ并发肺部感染８０例进行回顾性分析。结果病原体（除巨细胞病毒）分布：普通细菌４５例（５６％），结核杆菌２３例（２９％），真菌９例（１１％），卡氏肺囊虫３例（４％）。ＩＣＨ并发肺部感染的病死率，年龄＜６０岁为４８％，≥６０岁为６７％，并发菌血症的病死率为８６％，无菌血症的病死率为４５％，白细胞计数＞１０×１０９／Ｌ和＜４０×１０９／Ｌ的病死率分别为６７％，８７％，（４０～１０）×１０９／Ｌ病死率为２３％，弥漫性病灶和局限性病灶病死率分别为６５％和２３％（Ｐ＜０．０５，Ｐ＜０．０１）。ＩＣＨ并发肺部感染的病死率在年龄、有无菌血症、白细胞计数高低、病灶累及范围方面差异有显著性。病死率在性别、基础疾病、病原体种类、混合感染方面差异无显著性（Ｐ＞０．０５）。结论细菌是ＩＣＨ肺部感染最常见的病原体之一，在我国ＩＣＨ肺结核的激活和复燃应引起足够重视。

Objective To explore the distribution of etiological agents and death relating factors of pulmonary infections in immunocompromised hosts(ICH). Method 80 patients of pulmonary infections in ICH confirmed by etiological and(or)pathological diagnosis were retrospectively analyzed. Result The distribution of etiological agents of pulmonary infections (except for cytomegalovirus, CMV): common bacteria 56%, mycobacterium tuberculosis 29%、fungus 11%,pneumocystis carinii 4%. Mortality of pulmonary infections in ICH showed significant difference between age 67%(≥60 years):48%(<60 years), bacteremia 86%(yes):45%(no), white blood cell count 67%, 87%(>10×10 9 /L, <4.0×10 9/L):23%(4.0～10)×10 9/L,extent of lesions in x ray film 65%(diffuse):23%(local)( P <0.05, P <0.01),however, there was no obvious difference in sex、underlying diseases, types of etiological agents、mixed infections. Conclusion Bacteria was one of the most common etiological agents of pulmonary infections in ICH, the latent reactivation and relapse of pulmonary tuberculosis in ICH should be emphasized sufficiently. The preliminary analysis of death relating factors showed :age, bacteremia, white blood cell count, extent of lesions in x ray film were related to the prognosis of pulmonary infections in ICH.