COPD合并侵袭性肺曲霉菌病的危险因素及临床特点分析

Risk factors and clinical characteristics of COPD combined with invasive pulmonary aspergillosis

目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)的危险因素及临床特点。方法收集2012年2月至2015年3月柳州市各医院住院接受治疗的960例COPD患者,其中COPD合并IPA 42例(感染组),剩余918例均为未合并IPA病例(非感染组)。分析COPD合并IPA的相关因素及其临床特点、治疗方法和疗效。结果 (1)单因素分析结果显示:感染组与非感染组在长期应用激素、合并糖尿病、机械通气、应用抗菌药物时间及血清白蛋白水平差异均具有统计学意义(P均<0.01)。(2)经多元Logistic回归分析,影响COPD合并IPA相关因素包括:是否合并糖尿病、血清白蛋白水平及是否长期使用抗菌药物(P<0.05,P<0.01)。(3)感染组咳嗽咳痰、呼吸困难、发热、白细胞较正常升高或降低、C反应蛋白升高、GM实验阳性等临床症状发生率均高于非感染组(P<0.05,P<0.01)。(4)感染组病灶周围"晕征"、单发或者多发空洞、新月征发生率均高于非感染组(P均<0.01)。(5)42例患者分别采用了卡泊芬净与伏立康唑进行治疗,治疗有效率均为83.33%。结论影响COPD合并IPA的相关因素有合并糖尿病、血清白蛋白水平及长期使用抗菌药物,应积极对危险因素加以干预;临床医师应该不断增强对该病的认识,对高危患者,应及时行痰培养、GM实验、胸部CT、病灶活检等检查,以达到尽早诊断,及时治疗,改善预后。

Objective To investigate the risk factors and clinical features of chronic obstructive pulmonary diseases（ COPD） combined with invasive pulmonary aspergillosis（ IPA）. Methods A total of 960 patients with COPD treated in Liuzhou various hospitals between February 2010 and March 2015 were divided into infection group（ n = 42） and non-infection group（ n = 918） according to whether or not to combine with IPA. The factors related to COPD combined with IPA,the clinical features,the therapeutic method and efficacy were analyzed. Results Single factor analysis showed that there were significant differences in long term use of hormone,diabetes mellitus,use of mechanical ventilation,time using antimicrobial agents and serum albumin level between two groups（ all P〈0. 01）. Multiple Logistic regression analysis showed that the influencing factors related to COPD combined with IPA were whether or not to combine with diabetes,serum albumin level and whether or not to use antimicrobial agents long-term（ P〈0. 05 or P〈0. 01）. The incidences of cough and expectoration,dyspnea,fever,higher or lower leucocyte count than normal,elevated C reactive protein and positive galactomanan test（ GM test） in infection group were significantly higher than those in non-infection group（ P〈0. 05 or P〈0. 01）. The CT findings showed that the incidences of ＂ halo sign＂ around the lesions,single or multiple hollows, ＂ crescent sign＂ in infection group were significantly higher than those in non-infection group（ all P〈0. 01）. The patients in infection group were administered by caspofungin and voriconazole,respectively,and their total effective rates were all 83. 33%. Conclusions The influencing factors related to COPD combined with IPA include diabetes,serum albumin level,using antimicrobial agents long-term,and the intervention measures against the risk factors should be adopted. The clinician should enhance awareness of the disease,and the checkup on sputum culture,GM test,chest CT and lesion biopsy should be timely performed to attain early diagnosis,prompt treatment and improvement of prognosis.