免疫性大疱病患者口腔念珠菌感染的危险因素分析

Risk Factors of Oral Candida Infection in Patients with Immune Bullous Disease

目的探讨免疫性大疱病患者发生口腔念珠菌感染的危险因素。方法回顾性分析2012年1月-2018年9月于本院皮肤科收治的86例免疫性大疱病患者,根据口腔真菌检查结果,将病例分为念珠菌阳性组、念珠菌阴性组。首先对各种影响因素(疱病类型、性别、年龄、病程、激素服用时间、激素初始剂量、激素累积剂量、环孢素使用情况、发病季节、基础疾病)进行单因素分析,然后将差异有统计学意义的因素纳入多因素Logistic回归分析。结果86例免疫性大疱病患者中,发生口腔念珠菌感染42例,感染率为48.84%。激素累积剂量>3 g、使用环孢素、合并糖尿病、合并低蛋白血症、高龄(年龄≥70岁)、病程长,口腔念珠菌感染率高,差异具有统计学意义(P<0.05);疱病类型、性别、激素初始剂量、激素服用时间、环孢素累积剂量、合并慢性胃炎、合并慢性阻塞性肺疾病、合并高血压、合并血红蛋白<120 g/L,与口腔念珠菌感染的发生无关(P>0.05)。多因素Logistic回归分析显示:激素累积剂量>3 g、合并糖尿病、合并低蛋白血症、使用环孢素四种因素,差异具有统计学意义(P<0.05,OR值>1)。结论免疫性大疱病患者口腔念珠菌感染发生率高。激素累积剂量>3 g、合并糖尿病、合并低蛋白血症、使用环孢素是免疫性大疱病患者发生口腔念珠菌感染的独立危险因素。

Objective To investigate the risk factors of oral candida infection in patients with immune bullous disease.Methods Retrospective analysis of the clinical data of 86 admitted patients with immune bullous disease in our dermatology department from January 2012 to September 2018.According to the results of oral fungal examination,the cases were divided into candida positive group and candida negative group.First of all,univariate analysis was conducted on the factors including types,gender,age,duration,initial dose and cumulative dose of corticoid,use cyclosporine,the onset season,the underlying diseases,and then the factors with statistically significant differences were included in the multivariate logistic regression analysis.Results Among the 86 collected patients,42 were positive for oral Candida infection,with a positive rate of 48.84%.The factors including cumulative dose of corticoid(>3 g),the using of cyclosporin,with diabetes mellitus(DM),with hypoproteinemia,senior age(≥70 years),long natural history will lead to high oral candida infection rate.The difference was statistically significant by chi-square test or t-test(P<0.05).The other factors such as type of blister,gender,initial dose of corticoid,the taking time of corticoid,cumulative dose of cyclosporine,with chronic gastritis,chronic obstructive pulmonary disease,hypertension and hemoglobin<120 g/L,were not associated with oral candida infection(P>0.05).Multivariate logistic regression analysis showed that the cumulative dose of corticoid(>3 g),with DM,with hypoproteinemia and the using of cyclosporin were all P<0.05,OR value>1,and the difference was statistically significant.Conclusion There is a high incidence of oral candida infection in patients with immun bullous disease.Independent risk factors of oral candida infection in patients with immune bullous disease are cumulative dose of corticoid(>3 g),with DM,with hypoproteinemia and the using of cyclosporin.