慢性阻塞性肺疾病急性加重期患者肺部真菌感染的影响因素研究

Influencing Factors of Pulmonary Fungal Infection in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者肺部真菌感染的影响因素。方法选取2011年5月—2013年7月新疆医科大学第六附属医院收治的AECOPD继发肺部真菌感染患者73例作为试验组,另选择同期收治的AECOPD未继发肺部真菌感染患者80例作为对照组。比较两组患者临床资料,AECOPD患者肺部真菌感染的影响因素分析采用多因素Logistic回归分析。结果本组73例继发肺部真菌感染患者共培养出真菌115株,其中白假丝酵母菌63株,占54.78%;其他假丝酵母菌31株,占26.96%;曲霉菌21株,占18.26%。两组患者性别和肾功能不全发生率比较,差异均无统计学意义(P>0.05);试验组患者年龄大于对照组,肺源性心脏病、糖尿病、呼吸衰竭发生率及行机械通气者所占比例高于对照组,抗生素使用时间、激素使用时间及入住ICU时间长于对照组,清蛋白水平低于对照组(P<0.05)。多因素Logistic回归分析结果显示,年龄[OR=1.036,95%CI(1.021,1.050)]、肺源性心脏病[OR=1.096,95%CI(1.079,1.114)]、糖尿病[OR=3.177,95%CI(2.340,6.437)]、呼吸衰竭[OR=1.070,95%CI(1.040,1.102)]、抗生素使用时间[OR=4.059,95%CI(2.273,7.250)]、激素使用时间[OR=3.725,95%CI(2.061,6.733)]、入住ICU时间[OR=1.040,95%CI(1.020,1.059)]及机械通气[OR=3.380,95%CI(1.878,6.086)]是AECOPD患者肺部真菌感染的危险因素,清蛋白水平[OR=0.903,95%CI(0.868,0.939)]是AECOPD患者肺部真菌感染的保护因素(P<0.05)。结论 AECOPD患者肺部真菌感染的主要致病菌是白假丝酵母菌,且年龄、肺源性心脏病、糖尿病、呼吸衰竭、抗生素使用时间、激素使用时间、入住ICU时间、机械通气及清蛋白水平是AECOPD患者继发肺部真菌感染的影响因素,应引起临床重视。

Objective To analyze the influencing factors of pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods From May 2011 to July 2013 in the Sixth Affiliated Hospital of Xinjiang Medical University,a total of 73 AECOPD patients complicated with pulmonary fungal infection were selected as test group,meanwhile a total of 80 patients with AECOPD were selected as control group. Clinical data was compared between the two groups,and influencing factors of pulmonary fungal infection in patients with AECOPD were analyzed by multivariate Logistic regression analysis. Results Of the 73 AECOPD patients complicated with pulmonary fungal infection,a total of 115 strains of fungus were cultured out,including 63 strains of candida albicans(accounting for 54. 78%),31 strains of other candida(accounting for 26. 96%),21 strains of aspergillus(accounting for 18. 26%). No statistically significant differences of gender or incidence of renal insufficiency was found between the two groups(P > 0. 05); age of test group was statistically significantly elder than that of control group,incidence of pulmonary heart disease,diabetes and respiratory failure,and proportion of patients undergoing mechanical ventilation of test group were statistically significantly higher than those of control group,duration of using antibiotics and hormone,and ICU stays of test group were statistically significantly longer than those of control group,while albumin of test group was statistically significantly lower than that of control group(P < 0. 05). Multivariate Logistic regression analysis results showed that,age [OR = 1. 036,95% CI(1. 021,1. 050) ],pulmonary heart disease [OR= 1. 096,95% CI(1. 079,1. 114) ], diabetes [OR = 3. 177,95% CI(2. 340,6. 437) ], respiratory failure [OR =1. 070,95% CI(1. 040,1. 102) ], duration of using antibiotics [OR = 4. 059,95% CI(2. 273,7. 250) ], duration of using hormone [OR = 3. 725,95% CI(2. 061, 6. 733) ], ICU stays [OR = 1. 040, 95% CI(1. 020, 1. 059) ] and mechanical ventilation [OR = 3. 380,95% CI(1. 878,6. 086) ] were risk factors of pulmonary fungal infection in patients with AECOPD,while albumin [OR = 0. 903,95% CI(0. 868,0. 939) ] was the protective factor(P < 0. 05). Conclusion Candida albicans in the major pathogenic bacteria of pulmonary fungal infection in patients with AECOPD,age,pulmonary heart disease,diabetes, respiratory failure, duration of using antibiotics and hormone, ICU stays, mechanical ventilation and albumin are influencing factors of pulmonary fungal infection in patients with AECOPD,which should pay more attentions to.