慢性阻塞性肺疾病发生变应性支气管肺曲霉病危险因素分析

Analysis of risk factors of allergic bronchopulmonary aspergillosis in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD,简称慢阻肺)发生变应性支气管肺曲霉病(ABPA)的危险因素,为早期诊断和预防该病提供依据。方法选取郑州大学第一附属医院2015年8月至2020年8月收治的慢阻肺合并ABPA患者36例作为病例组,按1:2选取同时段入院、性别相同、年龄差不超过5岁的COPD未合并ABPA患者72例纳入对照组。对两组资料进行回顾性研究。结果两组性别、年龄、职业、基础疾病、症状比较差异无统计学意义(P>0.05);影像学纵隔淋巴结肿大差异具有统计学意义(P<0.05);实验室检查两组外周血嗜酸性粒细胞(EOS)计数比较差异具有统计学意义(P<0.05)。病例组肺功能34例(94%)为III~IV级,两组肺功能比较差异不具有统计学意义(P>0.05)。经单因素分析住院时长、有创操作、近1年内因慢阻肺急性加重(AECOPD)住院≥2次、重症监护室(ICU)治疗、用两种及以上抗生素与COPD发生ABPA相关(P<0.05)。经多因素Logistic回归分析,ICU治疗、有创操作、近1年内因AECOPD住院≥2次是COPD发生ABPA的独立危险因素(P<0.05或<0.01)。结论ICU治疗、有创操作、近1年内因AECOPD入院≥2次是COPD发生ABPA的主要危险因素,应提高警惕,以便早期诊断和预防ABPA的发生。

Objective To explore the risk factors of allergic bronchopulmonary aspergillosis(ABPA)in patients with chronic obstructive pulmonary disease(COPD),and provide evidence for early diagnosis and prevention of this disease.Methods 36 patients with COPD combined with ABPA treated in the First Affiliated Hospital of Zhengzhou University from August 2015 to August 2020 were selected as the case group.A control group of 72 COPD patients without ABPA were 1:2 matched by the time of admission,gender,and age(±5 years).All data were retrospective reviewed and compared between the two groups.Results There was no statistically significant difference in gender,age,occupation,underlying diseases,and symptoms between the two groups(P>0.05),while the differences in imaging mediastinal lymphadenopathy and peripheral blood eosinophil(EOS)counts were statistically significant(P<0.05).The pulmonary function of 34 cases(94%)in the case group was grade III~IV,and the difference in pulmonary function between the two groups was not statistically significant(P>0.05).Univariate analysis revealed that the length of hospitalization,invasive operation,hospitalizations due to acute exacerbation of chronic obstructive pulmonary(AECOPD)≥2 times in the past year,intensive care unit(ICU)treatment and use of two or more antibiotics were related to the occurrence of ABPA in COPD(P<0.05).After multivariate logistic regression analysis,ICU treatment,invasive procedures,and≥2 hospitalizations due to AECOPD in the past year were independent risk factors for the occurrence of ABPA in COPD(P<0.05 or<0.01).Conclusion ICU treatment,invasive operation,and≥2 hospitalizations due to AECOPD within 1 year are the main risk factors for ABPA in COPD,and we should be vigilant for early diagnosis and prevention of ABPA.