原发性肾病综合征合并肺部感染的病原菌分布及中医证候分析

Distribution of Pathogens in Primary Nephrotic Syndrome with Pulmonary Infection and Analysis of Traditional Chinese Medicine Syndrome

目的:分析原发性肾病综合征患者合并肺部感染的病原菌分布及耐药规律、中医证候特点,指导临床经验性用药。方法:对180例原发性肾病综合征合并肺部感染患者的临床资料进行分析。结果:180例患者中,男性117例,占65%;40岁以上患者占73.33%;膜性肾病为最常见的病理类型,占40%;革兰阴性菌为主要的致病菌,占51.72%;哌拉西林/他唑巴坦、亚胺培南、丁胺卡那霉素、庆大霉素的耐药率最低,三代头孢、喹诺酮类抗生素居中;中医证候中气虚痰湿内阻证患者所占比例最高,为25.56%,其次是痰热阻肺证17.78%,风邪犯肺证13.33%,气虚痰热内阻证9.45%,气虚血瘀水停证8.89%;虚实夹杂证占59.45%,且以气虚为主。结论:中老年男性、病理类型为膜性肾病的肾病综合征患者合并肺部感染的几率高;致病菌以革兰氏阴性菌多见,抗生素选择应以哌拉西林/他唑巴坦、三代头孢类为主;中医证候以气虚痰湿内阻最为常见。

This study was aimed to analyze the pathogen distribution, drug resistance and traditional Chinese medicine（TCM） syndrome of patients with primary nephrotic syndrome complicated with pulmonary infection for the guidance of clinical practice. The clinical data of 180 patients with primary nephrotic syndrome complicated with pulmonary infection were analyzed. The results showed that among 180 patients, 117 were male, accounting for 65%; 73.33% of them were over 40 years old. Membranous nephropathy was the most common pathological type, accounting for 40%.Gram-negative bacteria were the main pathogen, accounting for 51.72%. The drug resistance rates of piperacillin/tazobactam, imipenem, amikacin, gentamicin were the lowest. The drug resistance rates of third generation of cephalosporins and quinolone antibiotics were in the middle. In TCM syndrome differentiation, central qi deficiency and phlegm syndrome occupied the highest proportion, accounting for 25.56%; and the phlegm heat in the lung syndrome,accounting for 17.78%; wind evil attacking the lung syndrome, accounting for 13.33%; qi deficiency and phlegm syndrome, accounting for 9.45%; qi deficiency, blood stasis and water stagnation syndrome, accounting for 8.89%; the mixture of deficiency and excess syndrome, accounting for 59.45%, with qi deficiency as the main part. It was concluded that middle-aged and older men,pathologic type of membranous nephropathy had the higher rate of suffering pulmonary infection. Gram-negative bacteria were the main pathogen. The choice of antibiotics should be based on piperacillin/tazobactam, and third generation of cephalosporins. Qi deficiency and phlegm syndrome was the most common TCM syndrome.