老年2型糖尿病肺结核患者合并医院获得性肺炎的危险因素研究

Risk Factors of Hospital Acquired Pneumonia in Elderly Tuberculosis Patients Complicated with Type 2 Diabetes Mellitus

目的探讨老年2型糖尿病肺结核患者合并医院获得性肺炎(HAP)的危险因素,为临床防治肺部感染提供参考。方法选择2011年2月—2014年2月邢台市第二医院收治的老年2型糖尿病肺结核合并HAP患者92例作为病例组,采用1∶2配对的病例对照研究方法,选取同期收治的未合并HAP的老年2型糖尿病肺结核患者184例作为对照组。制定统一表格,收集两组患者入院时临床资料、影像学资料、痰抗酸杆菌涂片及血清抗结核抗体检测情况、感染前红细胞沉降率(ESR)、空腹血糖、糖化血红蛋白、餐后2 h血糖、营养状况(血红蛋白及血清清蛋白)及住院时间等,并分析病例组患者病原菌分布情况。老年2型糖尿病肺结核患者合并HAP的危险因素分析采用单因素分析及二分类Logistic回归分析。结果病例组患者分离出104株病原菌,其中革兰阴性杆菌占63.4%、革兰阳性菌占22.1%、真菌占14.4%。二分类Logistic回归分析结果显示,年龄>70岁〔OR=1.738,95%CI(1.578,4.256)〕、肺结核病程>5年〔OR=2.114,95%CI(1.370,4.211)〕、空洞数量≥3个肺野〔OR=2.267,95%CI(2.015,7.232)〕、有合并症〔OR=2.310,95%CI(2.145,5.452)〕、餐后2 h血糖≥11.0 mmol/L〔OR=1.335,95%CI(1.182,1.894)〕是老年2型糖尿病肺结核患者合并HAP的危险因素。结论年龄>70岁、肺结核病程>5年、空洞数量≥3个肺野、有合并症及餐后2 h血糖≥11.0 mmol/L是老年2型糖尿病肺结核患者合并HAP的独立危险因素,临床上应针对以上危险因素加强感染控制措施以降低HAP发生率。

Objective To investigate the risk factors of hospital acquired pneumonia（HAP） in elderly tuberculosis patients complicated with type 2 diabetes mellitus（T2DM）,to provide references for clinical prevention and treatment of pulmonary infection.Methods From February 2011 to February 2014,a total of 92 tuberculosis patients complicated with T2 DM and HAP were selected as case group in the Second Hospital of Xingtai,and 184 tuberculosis patients complicated with T2 DM were selected as control group according to 1 ∶ 2 matched case-control study method.Clinical data,imaging data,sputum smear for acid-fast bacillus,tubercle bacillus antibodies,ESR before infection,FPG,Hb A1 c,2 h FPG,Hb,ALB and hospital stays of the two groups were collected,pathogenic bacteria distribution of case group was analyzed.Univariate analysis and binary Logistic regression analysis were used to analyze the risk factors of HAP in elderly tuberculosis patients complicated with T2 DM.Results A total of 104 strains of pathogenic bacteria were isolated in case group,including gram-negative bacilli（63.4%）,gram-positive cocci（22.1%） and fungus（14.4%）.Binary Logistic regression analysis showed that,age 〉70 years old 〔OR = 1.738,95% CI（1.578,4.256） 〕,course of tuberculosis〉 5 years 〔OR = 2.114,95% CI（1.370,4.211） 〕,pulmonary fields tuberculous cavity ≥ 3 〔OR = 2.267,95% CI（2.015,7.232） 〕,occurrence of complications 〔OR = 2.310,95% CI（2.145,5.452） 〕,2 h FPG ≥ 11.0 mmol / L 〔OR = 1.335,95% CI（1.182,1.894） 〕 were risk factors of HAP in elderly tuberculosis patients complicated with T2 DM.Conclusion Age 70 years old,course of tuberculosis 〉5 years,pulmonary fields tuberculous cavity≥3,occurrence of complications,2 h FPG≥11.0 mmol / L are risk factors of HAP in elderly tuberculosis patients complicated with T2 DM,and targeted infection control measures should be made according to above risk factors,to reduce the incidence of HAP.