慢性阻塞性肺疾病合并真菌感染的危险因素与预后

Analysis of prognosis and risk factors for chronic obstructive pulmonary disease patients with pulmonary fungal infection

目的探讨慢性阻塞性肺疾病合并肺部真菌感染患者的相关危险因素与预后。方法对2008年1月～2012年12月201例慢性阻塞性肺疾病患者住院肺部真菌感染标本中真菌菌株进行培养鉴定，收集临床资料分析感染相关危险因子及预后。结果212株病原菌中，念珠菌占主要地位，占78．3％，其中白色念珠菌占60．8％，曲菌占21．6％。高效广谱抗生素、脏器功能不全和低白蛋白血症是慢性阻塞性肺疾病继发真菌感染的独立危险因素。合并真菌感染的临床表现无特异性，胸部CT表现以支气管肺炎为多见，早期抗真菌治疗预后较好，但需机械通气患者预后差。结论慢性阻塞性肺疾病患者院内肺部真菌感染病原菌以念珠菌及曲菌为主，曲菌、克柔念珠菌感染例数逐年有增多。真菌感染临床表现无特异性。需机械通气患者预后差。控制真菌感染发病率的主要途径是避免盲目使用高效广谱抗生素及糖皮质激素，预防医源性感染，提高患者免疫力。

Objective To investigate clinical features and risk factors and prognostic factors of patients with chronic obstructive pulmonary disease and pulmonary fungal infection. Methods 201 patients with chronic obstructive pulmonary disease patients were included. Respiratory specimens were cultured followed by identification, and data were collected for analysis of infection-related of risk factors and prognosis. Results In 212 pathogens, Candida accounted for 78.3 %, of which Candida albicans accounted for 60.8 %. Overdue antibiotics, and hypoalbuminemia, organ dysfunction were independent risk factors for chronic obstructive pulmonary disease with fungal infections. Clinical manifestations of fungal infection were not specific. The prognosis was good for those patients received early antifungal therapy, but was poor for those patients needing mechanical ventilation. Conclusion For chronic obstructive pulmonary disease patients with nosocomial pulmonary fungal infection, Candida and Aspergillus is the main pathogen. The important measure to re- duce the incidence of fungal infections is to avoid the misuse of broad-spectrum antibiotics, to prevent iatrogenic infection, and to improve the patient＇s immune system.