COPD继发肺部真菌感染的临床特征及发病相关因素分析

Clinical features of COPD patients with secondary pulmonary fungal infection and analysis of related factors

目的分析慢性阻塞性肺疾病(COPD)继发肺部真菌感染的临床特征及发病相关因素,为临床诊断治疗提供参考依据。方法选取2010年6月-2016年6月医院接诊的2 010例COPD患者为研究对象,回顾性分析COPD继发肺部真菌感染的临床特征,分析其发病相关因素;采用单因素及多因素logistic回归对COPD继发肺部真菌感染的易感因素进行分析。结果 2 010例COPD患者继发肺部真菌感染20例,感染率为1.0%;共检出真菌21株,以白念珠菌为主,13株占61.9%;COPD继发肺部真菌感染的临床症状以咳嗽、咳痰、发热等为主,与COPD患者比较未表现特异性;患者的年龄、住院时间、激素种类及疗程、抗菌药物种类及疗程和血浆白蛋白为COPD继发肺部真菌感染的相关因素(P<0.05);多因素分析表明,抗菌药物和激素疗程越长、住院时间久、血浆白蛋白低于正常值、存在侵袭性诊疗操作是继发真菌感染的主要危险因素。结论避免过度和盲目广谱抗菌药物及激素的使用,不仅可以降低COPD继发肺部真菌感染的发病率,还可以提高治疗效率、防止病情恶化。

OBJECTIVE To investigate the clinical features of chronic obstructive pulmonary disease （COPD） pa- tients with secondary pulmonary fungal infection and analyze the related factors so as to provide guidance fore clini- cal diagnosis and treatment. METHODS A total of 2 010 COPD patients who were treated in hospitals from Jun 2010 to Jun 2016 were recruited as the study objects. The clinical features of COPD with secondary pulmonary fun- gal infection were retrospectively analyzed, the related factors were analyzed, and the univariate analysis and mult- ivariate logistic regression analysis were performed for predisposing factors for the secondary pulmonary fungal in- fection in the COPD patients. RESULTS Of the 2 010 COPD patients, 20 had the secondary pulmonary fungal in- fection, with the infection rate 1.0~. Totally 21 strains of fungi were isolated, of which 61.90//oo （13 strains） were Candida albicans. Cough, expectoration, and fever were the major clinical symptoms of the COPD patients with secondary pulmonary fungal infection, as compared with the COPD patients, they did not show specific manifesta- tions. The related factors for the secondary pulmonary fungal infection in the COPD patients included the age, length of hospital stay, types of hormone and treatment course, types of antibiotic and treatment course, and plas- ma proteins （P^0.05）. The multivariate analysis indicated that the major risk factors for the secondary fungal in- fection included the long treatment courses of antibiotics and hormones, long length of hospital stay, plasma pro- tein level lower than the normal value, and invasive operations. CONCLUSION It is necessary to avoid the excessive and blind use of antibiotics and hormones so as to reduce the incidence of the secondary pulmonary fungal infection in the COPD patients, raise the effective rate of treatment, and prevent the deterioration of illness.