肺结核合并真菌性肺炎的临床特征及危险因素分析

Analysis of clinical features and risk factors of pulmonary tuberculosis complicated with fungal pneumonia

目的探讨肺结核合并真菌性肺炎的临床特征及危险因素,为临床防治提供一定参考依据。方法回顾性分析2016年8月~2018年7月武汉大学中南医院收治的109例肺结核患者临床资料,依据是否合并肺部真菌感染,分为合并感染组(44例)和单纯感染组(65例),对两组患者的临床症状和体征进行比较,对合并感染的危险因素进行单因素分析和多因素logistic回归分析。结果合并感染最常见类型为白色念珠菌(72.7%),合并感染患者出现咳痰比例显著高于单纯肺结核患者,差异有统计学意义(P<0.05)。单因素分析显示肺结核复治、病程长、广谱抗生素和糖皮质激素应用时间长的患者肺结核合并真菌性肺炎的发生率显著高于肺结核初治、病程短、广谱抗生素和糖皮质激素应用时间短的患者,差异有统计学意义(P<0.05);logistic分析显示肺结核复治、病程长、长时间使用广谱抗生素和糖皮质激素是合并感染的独立危险因素(P<0.05)。结论肺结核合并真菌感染患者咳痰较明显,复治肺结核、病程长、广谱抗生素和糖皮质激素应用时间长的患者要警惕合并真菌感染的可能,同时要做好针对性预防和早期诊治的宣教工作。

Objective To explore the clinical features and risk factors of pulmonary tuberculosis complicated with fungal pneumonia,and provide some reference for clinical prevention and treatment.Methods Clinical data of 109 cases of pulmonary tuberculosis admitted to from Aug.2016 to Jul.2018 were retrospectively analyzed.The patients were divided into the combined infection group(44 cases)and single infection group(65 cases)according to whether the patients were infected with pulmonary fungus.The clinical symptoms and signs of the patients in the two groups were compared,and the risk factors of co-infection were analyzed by univariate analysis and multivariate Logistic regression analysis.Results The most common type of co-infection was candida albicans(72.7%).The proportion of sputum and moist rale in patients with co-infection was significantly higher than that in patients with tuberculosis alone(P<0.05).Univariate analysis showed that the incidence of fungal pneumonia was significantly higher in patients with pulmonary tuberculosis complicated by repeat treatment,long course of disease,long duration of application of broad-spectrum antibiotics and glucocorticoids than in patients with initial treatment of pulmonary tuberculosis,short course of disease,short duration of application of broad-spectrum antibiotics and glucocorticoids(P<0.05).Logistic analysis showed that pulmonary tuberculosis relapse,long course of disease,long-term use of broad-spectrum antibiotics and glucocorticoids were independent risk factors for co-infection(P<0.05).Conclusion Patients with pulmonary tuberculosis complicated with fungal infection have obvious symptoms of cough and expectoration,and patients with pulmonary tuberculosis complicated with long course of disease,long application time of broad-spectrum antibiotics and glucocorticoids should be considered to the possibility of complicated with fungal infection,and at the same time,the propaganda of targeted prevention and early diagnosis and treatment should be done well.