类风湿性关节炎患者肺部真菌感染的危险因素分析

Risk factors for pulmonary fungal infections in patients with rheumatoid arthritis

目的观察类风湿性关节炎患者肺部真菌感染的危险因素及相应的诊治措施,以预防真菌感染。方法选择2008年3月-2013年5月就诊的62例类风湿性关节炎患者,调查分析患者年龄、性别、平均病程、糖皮质激素应用与否、是否合并肺间质纤维化、长期抗菌药物联合应用及实验室的检查指标等,观察引起肺部真菌感染的危险因素。结果 62例类风湿性关节炎患者出现肺部真菌感染28例,感染率为45.16%,检出的真菌中曲霉菌属19株占67.86%,白色假丝酵母菌5株占17.86%,新型隐球酵母菌1株占3.57%,其他真菌3株占10.71%;研究结果表明,>50岁、女性患者、病程较长、糖皮质激素的长期足量应用、合并肺间质纤维化及长期的抗菌药物联合应用均是类风湿性关节炎患者发生肺部真菌感染的危险因素,差异有统计学意义(P<0.05);实验室的检查指标白细胞计数、血沉和C-反应蛋白异常与类风湿性关节炎患者发生肺部真菌感染无明显相关,差异无统计学意义。结论针对研究结果可以指导相应的预防诊治方案,对于类风湿性关节炎患者要合理使用糖皮质激素,适时停用抗菌药物,避免患者出现肺部真菌感染,尽快使患者康复。

OBJECTIVE To observe the risk factors for puhnonary fungal infections in patients with rheumatoid arthritis and put forward corresponding treatment measures so as to prevent the fungal infections. METHODS A total of 62 cases of rheumatoid arthritis, who were treated in the hospital from Mar 2008 to May 2013, were enrolled in the study, then the age, gender, mean disease course, use of glucocorticoid, complication of pulmonary fibrosis, long-term combination use of antibiotics, and laboratory indicators were observed, and the risk factors for the pulmonary fungal infections were analyzed. RESULTS Of the 62 cases of rheumatoid arthritis, the pulmonary fungal infections occurred in 28 cases with the infection rate of 45. 16%. Among the fungi isolated, there were 19 （67.86%） strains of Aspergillus, 5 （17. 86%） strains of Candida albicans, 1 （3. 57%） strain of new Cryptococcus, and 3 （10.71%） strains of other species. The result of the study suggested that more than 50 years of age, long illness course, long-term and massive use of glucocorticoid, complication of pulmonary fibrosis, and long-term combination use of antibiotics were the risk factors for the pulmonary fungal infections （P〈0.05） ; while the laboratory examination indicators, including the white blood cell counts, erythrocyte sedimentation rate, and abnormal C-reactive protein, were not significantly correlated with the pulmonary fungal infections. CONCLUSION The corresponding prevention and treatment programs can be developed based on the result of the study. For the patients with rheumatoid arthritis, it is necessary to reasonably use cortieosteroids and withdrawal the antibiotics in a timely manner so as to prevent the pulmonary fungal infections and promote the rehabilitation of the patients.