肺部真菌感染123例临床特征及转归分析

Analysis on clinical features and outcome of pulmonary fungal infection in 123 cases

目的明确肺部真菌感染的危险因素和临床表现,以及治疗时机等因素对预后的影响。方法应用回顾性研究方法筛选出2014年1月至2016年12月重庆市九龙坡区人民医院诊断为肺部真菌感染患者123例,对临床资料进行汇总分析,根据指南将其分别归入拟诊组、临床诊断组和确诊组,比较各组转归,并采用logistic多因素回归分析影响肺部真菌感染预后的相关危险因素。结果 123例肺部真菌感染患者中拟诊63例,临床诊断57例,确诊3例。92.7%有基础疾病,以慢性呼吸系统疾病为主。123例患者全部接受抗真菌治疗,其中单药治疗96例(78.0%),多药治疗27例(22.0%)。治疗后病情好转68例(55.3%),死亡29例(23.6%),其他26例(21.1%);拟诊组、临床诊断组、确诊组的病死率分别为19.1%、28.1%、33.3%。logistic回归分析显示,低蛋白血症及侵袭性操作是影响预后的因素(P<0.05)。结论慢性阻塞性肺疾病基础、高血压是肺部真菌感染的高危人群。低蛋白血症及侵袭性操作可作为评价肺部真菌感染预后的主要指标。

Objective To determine the influence of risk factors,clinical features and treatment timing of pulmonary fungal infection（PFI） on prognosis. Methods The retrospective analysis method was adopted to select 123 cases of PFI in our hospital from January 2014 to December 2016. The clinical data were performed the summary analysis. The cases were included into the probable diagnosis group,clinical diagnosis group and definite diagnosis group according to the guide. The outcomes were compared among 3 groups. Furthemor the logistic multivariate regression analysis was adopted to analyze the related risk factors affecting PFI prognosis. Results Among 123 cases of PFI,63 cases were probable diagnosis,57 cases were clinical diagnosis and 3 cases were definite diagnosis. 92.7% of cases had basic diseases,which was mainly respiratory system diseases. All cases accepted anti-fungal therapy,including 96 cases（78.0%） of single drug treatment and 27 cases（22.0%） of multiple drugs treatment,68 cases（55.3%） were improved after treatment,29 cases（23.6%） died and 26 cases（21.1%） had other outcomes; the mortality rates of probable diagnosis group,clinical diagnosis group and definite diagnosis group were 19.1%,28.1% and 33.3%respectively. The logistic regression analysis results showed that the difference of hypoalbuminemia and invasive operation affect-ing prognosis was statistically significant（P〈0.05）. Conclusions The patients with chronic obstructive pulmonary disease and immunodeficiency are the high risk population of PFI. The forward shift of anti-fungal treatment timing may reduce the mortality rate. Hypoalbuminemia and invasive operation can serve as the main indicators for evaluating the prognosis of PFI.