发热伴血小板减少综合征合并真菌感染患者的临床特征与危险因素分析

CLINICAL FEATURES AND RISK FACTORS FOR FUNGAL INFECTION IN PATIENTS WITH SEVERE FEVER WITH THROMBOCYTOPENIA SYNDROME

目的探讨发热伴血小板减少综合征(SFTS)合并真菌感染患者的临床特征和可能危险因素。方法收集2013年7月—2020年6月于青岛市第六人民医院感染性疾病科住院治疗的SFTS患者临床资料,根据患者是否发生真菌感染分为病例组和对照组,病例组和对照组按相同年份1∶3匹配,记录患者主要临床症状和实验室指标,并进行单因素和多因素Logistic回归分析。结果SFTS患者合并真菌感染的发生率为15.13%;真菌感染部位多位于口咽、下呼吸道、食管及肠道;真菌类型多为白假丝酵母菌、近平滑假丝酵母菌、曲霉菌属、热带假丝酵母菌。合并真菌感染主要临床症状和体征有发热、厌食、咽痛、吞咽异物感、咳嗽咳痰、呼吸困难、胸痛、腹泻等。单因素分析结果显示,患者年龄、COPD病史、留置胃管情况、危重型SFTS、极期外周血CD4^(+)T细胞数(t=-4.820,χ^(2)=2.850~4.955,Z=-4.692,P<0.05)与SFTS患者合并真菌感染的发生有关。多因素分析结果显示,患者年龄(95%CI=1.044~1.191)和极期外周血CD4^(+)T细胞数(95%CI=0.986~0.996)为真菌感染的独立危险因素。结论SFTS合并真菌感染的发生率较高,对于年龄较大和极期外周血CD4^(+)T细胞数明显降低的患者,应注意其合并真菌感染的可能,加强观察,尽量早期诊断和及时干预。

Objective To investigate the clinical features and risk factors for fungal infection in patients with severe fever with thrombocytopenia syndrome(SFTS).Methods Clinical data were collected from the patients with SFTS who were hospitalized in Department of Infectious Diseases,The Sixth People’s Hospital of Qingdao,from July 2013 to June 2020,and according to the presence or absence of fungal infection,the patients were divided into case group and control group.The case group and the control group were matched at a ratio of 1∶3.Major clinical symptoms and laboratory indices were recorded,and univariate and multivariate logistic regression analyses were performed.Results The incidence rate of fungal infection was 15.13%in patients with SFTS,and common infection sites included the oropharynx,the lower respiratory tract,the esophagus,and the intestinal tract.Candida albicans,Candida parapsilosis,Aspergillus,and Candida tropicalis were the major types of fungus.Major clinical symptoms and signs of SFTS with fungal infection were pyrexia,anorexia,sore throat,foreign body sensation during swallowing,cough and expectoration,dyspnea,chest pain,and diarrhea.The univariate analysis showed that age,a medical history of chronic obstructive pulmonary disease,indwelling gastric tube,critical SFTS,and the number of CD4^(+)T cells in polar phase were associated with fungal infection in SFTS patients(t=-4.820,χ^(2)=2.850-4.955,Z=-4.692,P<0.05).The multivariate analysis showed that age(95%CI=1.044-1.191)and the number of CD4^(+)T cells in polar phase(95%CI=0.986-0.996)were independent risk factors for fungal infection.Conclusion There is a high incidence rate of fungal infection in SFTS patients.The possibility of fungal infection should be considered for patients with older age and a significant reduction in the number of peripheral blood CD4^(+)T cells in polar phase,and such patients should be closely observed for early diagnosis and timely intervention.