急性期慢性阻塞性肺疾病真菌感染高危因素分析及疗效观察

High risk factors and clinical efficacy of pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease

目的进一步探讨慢性阻塞性肺疾病急性加重患者继发真菌感染的高危因素,并分析临床诊断与拟诊患者在临床疗效及住院花费上是否存在差异。方法收集2014年1月~2017年8月期间在我院呼吸科住院的慢性阻塞性肺疾病急性加重患者的临床资料,并对患者的性别、年龄、病程、基础疾病、抗生素、糖皮质激素、住院时间、住院花费以及疗效进行统计分析。结果纳入633例AECOPD患者中,继发肺部真菌感染有90例,其中年龄≥70岁、病程≥10年、基础疾病≥2种、使用联合抗生素及全身使用糖皮质激素的AECOPD患者更易继发真菌感染(P<0.05)。继发真菌感染的AECOPD患者中确诊4例(由于例数较少,缺乏统计意义,予以剔除),临床诊断41例,拟诊45例,后两者在性别、年龄、病程、基础疾病、抗生素、糖皮质激素使用以及疗效方面无差异,但在住院时间(P=0.016)及花费(P=0.019)上拟诊组患者优于临床诊断组。结论对于采用常规抗感染治疗效果不佳的AECOPD患者应尽早评估是否存在真菌感染的高危因素。对于拟诊患者尽早抗真菌治疗,可缩短住院时间和减少花费。

Objective To further explore the high-risk factors of secondary fungal infection in patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD)and to analyze whether differences of clinical efficacy and expenses exist among the group of clinically diagnosed and suspected.Method This study to collect the clinical data of AECOPD from January 2014 to August 2017 in the Department of respiration in our hospital,and to analysis the sex,age,course of disease,basic disease,antibiotics,corticosteroids,hospitalization time,costs and clinical efficacy.Result This study included 633 AECOPD patients in total,90 cases with pulmonary fungal infection.The risk factors of secondary pulmonary fungal infection in COPD patients were age(≥70 years),course(≥10 years),basic diseases(≥2 kinds),the use of combination antibiotics and systemic hormone(P<0.05).Of 90 pulmonary fungal infection patients,4 cases were correctly diagnosed(excluded),41 cases were clinically diagnosed and 45 cases were suspected.No differences were observed on gender,age,course,basic diseases,the use of antibiotics and hormone,and clinical effects in the latter two groups,but the group of suspected was better than the group of clinically diagnosed on hospitalization time(P=0.016)and costs(P=0.019).Conclusion High risk factors for fungal infection should be assessed as early as possible for patients with AECOPD who were not adequately treated with conventional anti-infection therapy.Early antifungal therapy for suspected patients can reduce hospitalization time and costs.