肺结核患者住院期间并发肺部感染的高危因素分析

Analysis of high risk factors of pulmonary infection in patients with pulmonary tuberculosis during hospitalization

目的分析肺结核患者住院期间并发肺部感染的高危因素。方法回顾性分析2015年1月~2018年12月首都医科大学附属北京朝阳医院确诊400例肺结核患者的临床资料,根据是否肺部感染分为对照组(未感染者,328例)和研究组(感染者,72例),对肺结核并发症肺部感染的高危因素进行筛查。结果研究组年龄≥60岁、病程≥5年、吸烟史、糖尿病史、空洞肺结核、病变累及肺野数≥3个、肺结核复治、咯血、贫血、糖皮质激素长期使用史、广谱抗菌药物长期使用史及侵入性操作患者比例均明显高于对照组,差异有统计学意义(P <0.05)。肺结核复治、空洞肺结核、糖尿病史、糖皮质激素长期使用史、广谱抗菌药物长期使用史为肺结核合并肺部感染的危险因素(OR> 1,P <0.05)。结论肺结核患者较易并发肺部感染。肺结核复治、空洞肺结核、糖尿病、长期应用糖皮质激素和广谱抗菌药物是导致肺结核并发肺部感染的高危因素。临床需针对性采取干预措施,进而减少肺部感染发生率。

Objective To analysis the high risk factors of pulmonary infection in patients with pulmonary tuberculosis during hospitalization. Methods The clinical data of 400 patients with pulmonary tuberculosis confirmed in Beijing Chao-yang Hospital, Capital Medical University from January 2015 to December 2018 were analyzed retrospectively.According to whether pulmonary infection occurred, they were divided into control group(uninfected, 328 cases) and study group(infected, 72 cases). The high risk factors of pulmonary infection caused by pulmonary tuberculosis complications were screened. Results The age ≥60 years, course ≥5 years, smoking history, diabetes history, cavitary tuberculosis, number of lung fields involved ≥3, retreatment of tuberculosis, hemoptysis, anemia, long-term use history of glucocorticoids, long-term use history of broad-spectrum antibiotics and invasive operation in the study group were significantly higher than those in the control group, and the differences were statistically significant(P < 0.05). The retreatment of pulmonary tuberculosis, cavitary tuberculosis, diabetes history, long-term use history of glucocorticoids and long-term use history of broad-spectrum antibiotics were all high risk factors of pulmonary tuberculosis complicated with pulmonary infection(OR > 1, P < 0.05). Conclusion Pulmonary tuberculosis patients are more likely to be complicated with pulmonary infection. Retreatment of pulmonary tuberculosis, cavitary pulmonary tuberculosis, diabetes mellitus, long-term use of glucocorticoids and broad-spectrum antibiotics are the high risk factors of pulmonary tuberculosis complicated with pulmonary infection. Clinical intervention measures should be taken to reduce the incidence of pulmonary infection.