成人间质性肺疾病肺部真菌感染的危险因素

Risk factors for pulmonary fungal infection in adults with interstitial lung disease

目的观察成人间质性肺疾病(ILD)肺部真菌感染的危险因素,为成人间质性肺疾病肺部真菌感染的临床防治提供参考。方法将2017年8月-2019年12月在南阳市中心医院就诊,且病原学检查确诊为肺部真菌感染的37例ILD患者纳入感染组,另112例未发生肺部感染的ILD患者作为未感染组。比较两组一般资料及临床症状、实验室指标及影像学指标,多因素Logistic逐步回归分析成人ILD肺部真菌感染的危险因素。结果两组性别、年龄、体质指数(BMI)、病程、空腹血糖及皮疹、关节痛、口干眼干、晨僵、雷诺现象、肌肉痛比例差异均无统计学意义(P>0.05),但感染组低蛋白血症、使用免疫抑制剂、激素剂量≥30 mg/d、联合广谱抗生素、发热、咳嗽、咳痰、胸闷、气促及肺部干湿啰音比例均显著高于未感染组,差异有统计学意义(P<0.05)。两组白细胞(WBC)、肌酸激酶(CK)、球蛋白(GLB)、免疫球蛋白(Ig)M、IgG、补体C3、补体C4、循环免疫复合物(CIC)、血红蛋白(Hb)、血小板计数(PLT)及影像学征象比较差异无统计学意义(P>0.05),但感染组血小板与淋巴细胞比(PLR)、中性粒细胞与淋巴细胞比(NLR)、乳酸脱氢酶(LDH)、血沉(ESR)、C反应蛋白(CRP)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)显著高于未感染组,血清白蛋白(ALB)、CD4^(+)/CD8^(+)显著低于未感染组,差异有统计学意义(P<0.05)。Logistic逐步回归分析显示低蛋白血症、激素剂量≥30 mg/d、联合广谱抗生素、ESR、CRP均是成人ILD患者肺部真菌感染的独立危险因素,CD4^(+)/CD8^(+)是保护因素。结论成人ILD肺部真菌感染的影响因素繁杂,临床应重视合并危险因素的高危患者,积极防治以降低肺部真菌感染风险。

Objective To analyze the risk factors for pulmonary fungal infection in adults with interstitial lung disease(ILD),and provide reference for clinical prevention and treatment of the disease.Methods Thirty-seven patients with ILD and pathologically confirmed pulmonary fungal infection who were treated in the hospital between August 2017 and December 2019 were included in the infected group.Meanwhile,112 patients with ILD but without pulmonary infection were included in the uninfected group.General data,clinical symptoms,laboratory indexes and imaging indexes of the two groups were compared.Multivariate Logistic stepwise regression analysis of risk factors for pulmonary fungal infection in adults with ILD was performed.Results There were no significant differences in gender,age,body mass index(BMI),course of disease,fasting blood glucose and proportions of skin rash,joint pain,dry mouth,dry eyes,morning stiffness,Raynaud’s phenomenon and muscle pain between the two groups(P>0.05).However,proportions of hypoproteinemia,using immunosuppressants,hormone dose ≥30 mg/d,combined use of broad-spectrum antibiotics,fever,cough,expectoration,chest tightness,shortness of breath and dry and wet lung rales in infected group were significantly higher than those in uninfected group(P<0.05).There were no statistically significant differences in white blood cell(WBC),creatine kinase(CK),globulin(GLB),immunoglobulin(Ig)M,IgG,complement C3,complement C4,circulating immune complexes(CIC),hemoglobin(Hb),blood platelet count(PLT)and imaging signs between the two groups(P>0.05).Platelet-lymphocyte ratio(PLR),neutrophil-lymphocyte ratio(NLR),lactate dehydrogenase(LDH),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in infected group were significantly higher than those in uninfected group,while albumin(ALB)and CD4^(+)/CD8^(+)were significantly lower than uninfected group(P<0.05).Logistic stepwise regression analysis showed that hypoalbuminemia,hormone dose ≥30 mg/d,combined use of broad-spectrum antibiotics,ESR and CRP were independent risk factors for pulmonary fungal infection in adults with ILD,and CD4^(+)/CD8^(+)was a protective factor.Conclusions Influencing factors of pulmonary fungal infection in adults with ILD were complex.Attention should be paid to patients with risk factors,and active prevention and treatment should be carried out to reduce the risk of pulmonary fungal infection.