慢性阻塞性肺疾病急性加重期患者肺部真菌感染的相关因素分析

Related factors for pulmonary fungal infections 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相关因素分析,为临床感染预防和控制工作提供客观依据。方法选取医院2012年1月-2016年12月收治的543例AECOPD患者作为研究对象,对AECOPD患者发生肺部真菌感染情况、病原菌分布及相关影响因素进行观察和分析。结果 543例AECOPD患者中有79例最终确诊为合并肺部真菌感染,感染率为14.55%,共检出94株病原菌,白假丝酵母、热带假丝酵母、克柔假丝酵母为主要病原菌;单因素分析结果显示,合并糖尿病、机械通气、长期应用激素、应用抗菌药物时间、血浆白蛋白水平是AECOPD患者发生肺部真菌感染的影响因素,Logistic多元回归分析显示,AECOPD患者合并肺部真菌感染的发生与合并糖尿病、应用抗菌药物时间较长、血浆白蛋白水平较低具有相关性(P<0.05)。结论 AECOPD合并肺部真菌感染的病原菌以白假丝酵母为主,其感染风险与患者的自身状态和治疗因素均有关,临床医师应给予高度重视和密切监测,及时采取干预措施,提高诊治水平,以改善患者的预后。

OBJECTIVE To explore the related factors for pulmonary fungal infections in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）so as to provide objective basis for prevention and control of clinical infections.METHODS A total of 543 patients with AECOPD who were treated in the hospital from Jan 2012 to Dec 2016 were recruited as the study objects.The incidence of pulmonary fungal infections,distribution of pathogens and influencing factors for the infection were observed.RESULTS Of the 543 patients with AECOPD,79 were finally diagnosed with pulmonary fungal infections,with the infection rate 14.55%.Totally 94 strains of pathogens were isolated,and Candida albicans,Candida tropicalis and Candida krusei were the major species of pathogens.The result of univariate analysis showed that the influencing factors for the pulmonary fungal infections in the AECOPD patients included complication with diabetes mellitus,mechanical ventilation,long-term use of hormones,time of use of antibiotics and plasma albumin level.Multivariate logistic regression analysis indicated that the incidence of pulmonary fungal infections in the AECOPD patients was associated with the complication with diabetes mellitus,long-term use of antibiotics and low level of plasma albumin level（P〈0.05）.CONCLUSIONThe C.albicans is dominant among the pathogens causing the pulmonary fungal infections in the AECOPD patients,and the risk of infection is associated with the patients′state of their own and treatment factors.It is necessary for the clinicians to pay great attention,focus on the monitoring and take intervention measures so as to raise the level of diagnosis and treatment and improve the prognosis of the patients.