真菌感染与AECOPD的关系及其危险因素分析

Relationship between fungal infection and AECOPD and its risk factors

目的探讨真菌与AECOPD的关系及其危险因素。方法选取我院收治的(AECOPD)住院患者78例作为研究对象,按痰真菌培养结果分为阴性患者(40例A组)与阳性患者(38例B组),分析AECOPD发病及加重与真菌感染的关系。结果 78例AECOPD患者,均采用抗生素、化痰、止咳及各种对症支持及少量喷雾化激素。总共检查病毒呈现为阴性40例,检出真菌感染38株,其中白色念珠菌最高18株,41.18%,其次是光滑念珠菌10株,22.06%,曲真菌5株,13.23%;A组与B组的血清Cr水平相比,A组治疗后血清Cys-C、CRP水平均低于对照组,GFR治疗后低于治疗前,组间差异有统计学意义(P<0.05);两组治疗后PaO_2值上升,PaCO_2值下降,治疗后较治疗前均有改善,且治疗后A组较B组明显疗效好,差异具有统计学意义(P<0.05);两组经治疗后血清IgG、IgA、IgM水平均有所增加,经治疗后的CD^+_3、CD^+_4的水平均高于治疗前,CD^+_8指标水平降低,CD^+_4/CD^+_8治疗后均高于治疗前,且治疗后A组优于B组,差异具有统计学意义(P<0.05);两组均采用抗生素、化痰、止咳及各种对症支持及少量喷雾化激素,A组治疗后FEV_1、PEF、FEV_1/FVC均高于B组(P<0.05)。结论真菌感染是造成AECOPD加重的重要诱因,且AECOPD加重期阶段真菌感染检出率较高,临床中应该重视AECOPD患者的真菌感染。

Objective To investigate the relationship between fungal infection and AECOPD and its risk factors. Methods A total of 78 inpatients with acute exacerbation of chronic obstructive pulmonary disease admitted to our hospital were enrolled in this study, and they were divided into the negative patients (40 patients in the group A) and the positive patients (38 patients in the group B). The relationship of the incidence and aggravation of AECOPD with fungal infection was analyzed. Results 78 patients with AECOPD were all given antibiotics, phlegm dissipation, cough relieve, various supportive nutrition and little atomizing hormone. 40 cases of them were negative, and 38 cases were fungal infection, including 18 strains of candida albicans (41.18%), 10 strains of smooth monilia (22.06%), and 5 strains of Aspergillus fungus (13.23%). The levels of serum Cys-C and CRP was lower in the group A than in the group B after treatment, and the level of GFR decreased obviously after treatment ( P< 0.05). The value of PaO 2 decreased, and the value of PaCO 2 increased after treatment, and the improvement was more pronounced in the group A than in the group B ( P< 0.05). The levels of serum IgG, IgA and IgM increased after treatment, and the value of CD + 3, CD + 4, CD + 4/CD + 8 increased after treatment, and the value of CD + 8 decreased. The above indexes were better in the group A than in the group B ( P< 0.05). Conclusion Fungal infection is the key cause of AECOPD aggravation, and the detection rate of fungal infection is high in the stage of AECOPD exacerbation. The clinical infection should be emphasized in patients with AECOPD.