慢性阻塞性肺疾病并发侵袭性肺曲霉菌病的临床特征和危险因素分析

Analysis of clinical characteristics and risk factors of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)并发侵袭性肺曲霉菌病(invasive pulmonary aspergillosis,IPA)的临床特征和危险因素。方法分析沧州市中心医院2015年12月至2016年12月收治的189例COPD患者的病历资料,将其中65例并发IPA的患者纳入观察组,124例未并发IPA的患者纳入对照组。分析两组患者的临床特征及COPD患者并发IPA的危险因素。结果观察组年龄≥60岁、呼吸困难、咯血、抗菌药物使用时间≥14天、机械通气、机械通气时间≥7天、C反应蛋白水平≥50 mg/L、球蛋白水平<20 g/L、动脉血氧分压<60 mm Hg及COPD分级为极重度的患者比例均显著高于对照组(P<0.05)。多因素Logistic回归分析显示,机械通气时间≥7天、COPD分级为极重度、抗菌药物使用时间≥14天是COPD并发IPA的主要危险因素(P<0.05)。结论 IPA是COPD患者病情危重的一项相关因素,机械通气时间≥7天、COPD分级为极重度、抗菌药物使用时间≥14天是COPD并发IPA的主要危险因素。

Objective To investigate the clinical characteristics and risk factors of invasive pulmonary asper-gillosis （IPA） in patients with chronic obstructive pulmonary disease （COPD）.Method 189 patients with COPD treated in Cangzhou Central Hospital from December 2015 to December 2016 were collected as objects of study, and 65 cases with IPA were included in observation group, 124 patients without IPA were included in control group. The clinical features and risk factors of IPA in patients with COPD were studied.Result The proportion of age≥60 years old, dyspnea, hemoptysis, antimicrobial drug use time≥14 days, mechanical ventilation, mechanical ventilation time≥7 days, C reactive protein level≥50 mg/L, Globulin level〈20 g/L, arterial partial pressure of oxygen〈60 mmHg and critically severe COPD grade in observation group were more than control group （P〈0.05）. Logistic regression analysis showed that, mechanical ventilation time≥7 days, antimicrobial drug use time≥14 days and critically severe COPD grade were risk factors of IPA in patients with COPD （P〈0.05）. Conclusion IPA is a related factors time of the severity in patients with COPD, and mechanical ventilation time≥7 days, antimicrobial drug use time≥14 days and critically severe COPD grade are risk factors of IPA in patients with COPD.