氟康唑预防重度慢性阻塞性肺疾病患者真菌感染的效果研究

Curative effect of fluconazole on prevention of severe chronic obstructive pulmonary disease patients with complicated fungal infections

目的探讨氟康唑预防重度慢性阻塞性肺疾病(COPD)患者真菌感染的疗效,以降低重度COPD患者肺部真菌感染率。方法选取2011年1月-2013年12月重度COPD患者100例为研究对象,随机分为观察组和对照组,各50例,对照组给予常规治疗,观察组在对照组基础上给予氟康唑预防治疗,对比分析两组患者真菌感染率、治疗前与治疗后体液免疫功能。结果预防治疗后观察组肺部真菌感染率为12.00%,显著低于对照组的28.00%,差异有统计学意义(P<0.05);预防治疗后观察组>60岁老年患者肺部真菌感染率为13.33%,显著低于对照组的35.71%,差异有统计学意义(P<0.05),两组<60岁患者真菌感染率差异无统计学意义;预防治疗后4周观察组和对照组血清IgG、IgM水平均较治疗前降低,但观察组降低幅度大于对照组,差异有统计学意义(P<0.05);观察组患者均未发生肝肾功能损害、皮疹及胃肠道反应等不良反应。结论氟康唑预防治疗老年重度COPD肺部真菌感染,可有效提高患者体液免疫功能、降低患者肺部真菌感染率、缩短住院时间、且安全性较高。

OBJECTIVE To explore the curative effect of fluconazole on prevention of the patients with severe chron‐ic obstructive pulmonary disease （COPD） complicated with fungal infections so as to reduce the incidence of pul‐monary fungal infections in the patients with severe COPD .METHODS From Jan 2011 to Dec 2013 ,totally 100 pa‐tients with severe COPD were recruited as the study objects and randomly divided into the observation group and the control group ,with 50 cases in each .The control group was treated with conventional nursing ,while the ob‐servation group was given the additional fluconazole on the basis of control group .The incidence of fungal infec‐tions was observed and compared between the two groups of patients ,and the humoral immunity was analyzed be‐fore and after the treatment .RESULTS After the treatment ,the incidence rate of pulmonary fungal infections of the observation group was 12 .00% ,significantly lower than 28 .00% of the control group（P〈 0 .05） .The inci‐dence rate of pulmonary fungal infections in the elderly patients aged more than 60 years old was 13 .33% ,signifi‐cantly lower than 35 .71% in the control group（P〈0 .05） ,while there was no significant difference in the inci‐dence of fungal infections in the patients aged less than 60 years old between the two groups .After the treatment for 4 weeks ,the levels of serum IgG and IgM of both the observation group and the control group were significant‐ly reduced ,however ,the reduced amplitudes were greater in the observation group than in the control group（P〈0 .05） .The adverse reactions such as liver and kidney dysfunction ,rash ,and gastrointestinal reaction did not occur in the patients of the observation group .CONCLUSION As used for the prevention of the elderly patients with se‐vere COPD complicated with pulmonary fungal infections ,fluconazole can effectively improve the humoral immuni‐ty ,reduce the incidence of pulmonary fungal infections ,and shorten the length of hospital stay ,with the safety hig h .