老年矽肺患者并发呼吸道感染危险因素的前瞻性临床研究

A prospective clinical study of the risk factors of respiratory infection in aged pneumosilicosis patients

目的探讨老年矽肺患者发生呼吸道感染的危险因素。方法以2009年3月至2010年9月在浙江大学医学院附属第一医院呼吸科门诊随访、病情稳定的老年矽肺患者为研究对象。记录入选时的一般情况、病史和血液生化指标,随访1年,记录随访期间是否发生呼吸道感染及发生的时间。根据随访期间是否发生呼吸道感染,分为矽肺伴感染组和矽肺不伴感染组,比较两组上述指标的差异,并进行多元回归分析,探讨老年矽肺患者发生呼吸道感染的危险因素。结果 (1)矽肺伴感染组糖尿病患者所占比例显著高于矽肺不伴感染组,差异有统计学意义(P<0.05);矽肺伴感染组白蛋白和CD4+/CD8+显著低于矽肺不伴感染组,差异有统计学意义(P<0.05);两组在高血压史、吸烟史、血肌酐、血红蛋白、白细胞、中性粒细胞百分率和CD3-CD19+等方面比较,差异无统计学意义(P>0.05)。(2)多元回归分析显示,有糖尿病史,1年内发生呼吸道感染的概率增加48.2%;白蛋白和CD4+/CD8+每降低一单位,老年矽肺患者1年内发生呼吸道感染的概率分别增加51.5%和160.5%。结论糖尿病、低蛋白血症和低CD4+/CD8+比值是老年矽肺患者发生呼吸道感染的独立危险因素。

Objective To evaluate the risk factors of respiratory infection in aged pneumosilicosis patients. Method 96 patients followed up in The First Affiliated Hospital of Medical School of Zhejiang University between Mar. 2009 and Sep. 2010 participated in the clinical trial. The basic information, medical history and biochemical data were recorded. During the 1 year follow up, the occurance of respiratory infection and the time period were recorded. Patients were divided into Observa- tion group （pneumosilicosis without respiratory infection） and Comparison group （pneumosilicosis with respiratory infection） based on whether they had the infection. The differences between the two groups were analysed using t test. Multiple regression analysis was performed. Result The proportion of diabetes mellitus in the Observation group was significantly higher than that of the Comparison group （P 〈 0.05 ） ; The levels of albumin and CD4^＋/CD8^＋ of the Comparison group were significantly lower than those of the Observation group （ P 〈 0.05 ）. Multiple regression analysis showed that low concentration of albumin, low radio of CD4 ^＋/CD8^＋ and diabetes mellitus were the risk factors of respiratory infection in aged pneumosilicosis patients. Con- clusion Low concentration of albumin, low radio of CD4 ^＋/CD8 ^＋ and diabetes mellitus are the risk factors of respiratory infection in aged pneumosilicosis patients.