COPD患者并发真菌感染的临床特点、危险因素及治疗效果分析

Clinical characteristics of and risk factors for a fungal infection in patients with COPD and their treatment response

目的探讨慢性阻塞性肺疾病(COPD)患者并发真菌感染的临床特点、危险因素和治疗效果。方法临床确诊COPD患者438例,采集血液、尿液、痰液、粪便等标本进行真菌培养检查,分析真菌感染发生率,感染部位、感染真菌种类及构成情况;调查COPD患者的相关临床资料,通过多因素Logistic回归分析法分析并发真菌感染的危险因素。对真菌感染者进行相应抗真菌治疗,观察治疗效果。结果 COPD患者并发真菌感染率为4.34%, 52.63%为呼吸道真菌感染。共检出真菌29株,其中17株(占58.62%)为白色假丝酵母菌。多因素Logistic回归分析法分析显示,侵入性操作、抗生素使用时间≥2周、累计使用糖皮质激素>500 mg为COPD并发真菌感染的危险因素(均P<0.05)。感染真菌的COPD患者给予抗真菌治疗,总有效率为68.42%,不良反应发生率为21.05%。结论呼吸道是COPD患者并发真菌感染的主要部位,白色假丝酵母菌是常见致病性真菌,侵入性操作、长期使用抗生素及过量使用糖皮质激素等为COPD患者发生真菌感染的风险因素,应引起高度重视。

Objective To investigate the clinical characteristics of and risk factors for a fungal infection in patients with chronic obstructive pulmonary disease(COPD)and their treatment response.Methods Subjects were 438 patients with clinically confirmed COPD.Samples of blood,urine,sputum,and feces were collected for fungal culture.The incidence of a fungal infection,the site of infection,the fungal species,and its prevalence were analyzed.Clinical data on patients with COPD were examined,and the risk factors for a fungal infection were analyzed using multivariate logistic regression analysis.Patients with fungal infection were treated with antifungal therapy,and the efficacy of that therapy was observed.Results The incidence of a fungal infection in patients with COPD was 4.34%,and 52.63%of patients had a respiratory fungal infection.Twenty-nine strains of fungi were detected,17(58.62%)of which were Candida albicans.Multivariate logistic regression analysis indicated that an invasive procedure,taking antibiotics≥2 weeks,and cumulative use of glucocorticoids>500 mg were risk factors for a fungal infection in patients with COPD(P<0.05).Antifungal therapy was given to patients with COPD and a fungal infection;overall efficacy was 68.42%,and the incidence of adverse reactions was 21.05%.Conclusion The respiratory tract is the main site for a fungal infection in patients with COPD,and C.albicans is the most common fungus.An invasive procedure,long-term use of antibiotics,and excessive use of glucocorticoids are risk factors for a fungal infection in patients with COPD,so greater attention should be paid to these factors.