维持性血液透析患者肺部感染的临床分析

Clinical analysis of pulmonary infection in maintenance hemodialysis patients

目的了解维持性血液透析(MHD)患者肺部感染的临床特点,并进行相关危险因素的分析。方法回顾性分析2017年1月~2019年12月在四川大学华西医院血透中心行维持性血液透析治疗的患者的临床资料。将因肺部感染住院的患者和未发生住院事件的患者进行比较,探索两组患者在人口学特征、合并症和实验室检查指标等方面的差异,并采用Logistic回归分析肺部感染的危险因素。同时总结MHD肺部感染的临床特点。结果研究共纳入48例肺部感染患者和140例未住院患者。与无住院事件组比较,肺部感染组平均年龄较大,合并糖尿病以及慢性阻塞性肺疾病(COPD)的比例更高(P<0.05);实验室指标中,感染组的血清白蛋白水平较低,而C反应蛋白(CRP)更高(P<0.05)。Logistic回归分析显示年龄大、合并COPD、低蛋白血症和CRP浓度增高是血液透析患者发生肺部感染的危险因素。MHD肺部感染中多重耐药菌感染率不高(5.6%)。结论MHD肺部感染的临床表现与普通社区获得性肺炎相似。高龄、合并COPD和营养不良炎症综合征的患者是肺部感染的高危人群。

Objective To explore the clinical characteristics of pulmonary infections in maintenance hemodialysis(MHD) patients and analyze related risk factors.Methods The clinical data of patients undergoing maintenance hemodialysis in West China Hospital of Sichuan University from January 2017 to December 2019 were retrospectively analyzed.Patients hospitalized for pulmonary infection were compared with those without hospitalization during this period.The differences in demographic characteristics,complications and laboratory indicators between the two groups of patients were explored.Logistic regression was used to analyze risk factors of pulmonary infection.The clinical characteristics of pulmonary infection in MHD patients were also summarized.Results A total of 48 patients with pulmonary infection and 140 non-hospitalized patients were enrolled in the study.Compared with the non-hospitalized group,the pulmonary infection group was older and had higher prevalence of diabetes and chronic obstructive pulmonary disease(COPD)(P<0.05).In terms of laboratory indicators,the infection group had lower level of serum albumin and higher level of C-reactive protein(P<0.05).Logistic regression analysis showed that older age,COPD,hypoproteinemia and elevated C-reactive protein were risk factors for pulmonary infection in hemodialysis patients.The infection rate of multidrug-resistant bacteria in MHD patients was not high(5.6%).Conclusion The clinical manifestations of pulmonary infection in MHD patients are similar to those of community-acquired pneumonia.Older patients with COPD and malnutrition-inflammation complex syndrome are at high risk of pulmonary infection.