老年慢性阻塞性肺疾病合并肺部真菌感染患者痰液标本病原菌分布情况及外周血presepsin、Hepcidin-25水平变化意义

The distribution of pathogenic bacteria in sputum samples of elderly COPD patients with pulmonary fungal infection and the significance of changes in the levels of presepsin and Hepcidin-25 in peripheral blood

目的研究老年慢性阻塞性肺疾病(COPD)合并肺部真菌感染患者痰液标本病原菌分布情况及外周血presepsin、Hepcidin-25水平变化意义。方法选取本院于2018年3月-2020年3月收治的102例老年COPD合并肺部真菌感染患者为研究对象,定义为合并感染组,并对其随访1年。同时选取同时期在本院就诊的单纯COPD患者88例,定义为COPD组,并招募62例年龄、性别与上述两组相匹配的健康志愿者,定义为对照组。观察合并感染组患者痰液标本病原菌分布情况。检测三组外周血presepsin、Hepcidin-25水平,将合并感染组根据随访期间因COPD合并肺部真菌感染发生死亡为依据分为存活组与死亡组,比较两组患者外周血presepsin、Hepcidin-25水平及其他可能影响因素。绘制合并组工作征曲线(ROC)判断老年COPD合并肺部真菌感染发生死亡的血浆presepsin、Hepcidin-25水平最佳截断值,根据最佳截断值分为高presepsin组和低presepsin组、高Hepcidin-25组和低Hepcidin-25组;采用Kaplan-Meier法绘制生存曲线,并采用COX比例风险模型分析影响COPD合并肺部真菌感染患者预后不良的危险因素。结果合并感染组102例患者共检出真菌5种,共126株,其中白色念菌珠菌66株,占64.71%;光滑念珠菌30株,占29.41%;热带念珠菌14株,占13.73%;毛霉菌9株,占8.82%;克柔念珠菌7株,占6.86%。合并感染组与COPD组患者血清presepsin、Hepcidin-25水平均高于对照组(P<0.05),合并组血清presepsin、Hepcidin-25水平高于COPD组(P<0.05)。单因素分析显示死亡组患者吸烟、两种及以上真菌感染、两种及以上器官功能衰竭的占比,外周血presepsin、Hepcidin-25水平高于存活组(P<0.05)。高presepsin组与低presepsin组患者生存曲线比较,差异有统计学意义(P<0.05)。高Hepcidin-25组与低Hepcidin-25组患者生存曲线比较,差异有统计学意义(P<0.05)。COX多因素分析显示,吸烟、两种及以上真菌感染、两种及以上器官功能衰竭、外周血presepsin≥245.65 pg/mL、Hepcidin-25≥38.31 ng/mL均是影响老年COPD合并肺部真菌感染患者发生死亡的危险因素(P<0.05)。结论老年COPD合并肺部真菌感染患者的真菌分布以白色念珠菌感染较为常见。血清presepsin、Hepcidin-25在老年COPD合并肺部真菌感染患者体内异常高表达,是影响老年COPD合并肺部真菌感染患者发生死亡的独立危险因素,其水平变化对患者预后有较高的预测价值。

Objective To study the distribution of pathogenic bacteria in sputum samples of elderly chronic obstructive pulmonary disease(COPD)patients with pulmonary fungal infection and the significance of changes in the levels of presepsin and Hepcidin-25 in peripheral blood.Methods A total of 102 elderly COPD patients with pulmonary fungal infection who were admitted to our hospital from March 2018 to March 2020 were selected as the research objects,and they were defined as the co-infection group and followed up for 1 year.At the same time,88 patients with simple COPD who were treated in our hospital during the same period were selected and defined as the COPD group,and 62 healthy volunteers matching the age and gender of the above two groups were recruited and defined as the control group.The distribution of pathogenic bacteria in sputum specimens of patients in the co-infection group were observed.The levels of presepsin and Hepcidin-25 in the peripheral blood of the three groups were detected.The combined infection group was divided into the survival group and the death group based on whether death occurred due to COPD combined with pulmonary fungal infection during the follow-up period.The levels of presepsinand Hepcidin-25 in the peripheral blood and other possible influencing factors of the two groups were compared.The combined receiver operating characteristic curve(ROC)was employed to determine the best cut-off values of plasma presepsin and Hepcidin-25 levels for deaths from older COPD patients with pulmonary fungal infection.According to the best cut-off values,they are divided into high presepsin group,low presepsin group,and high Hepcidin-25 groups and low Hepcidin-25 groups.The Kaplan-Meier method was used to draw the survival curve,and the COX proportional hazard model was used to analyze the risk factors that affect the poor prognosis of COPD patients with pulmonary fungal infection.Results A total of 5 species of fungi with 126 strains were detected in 102 patients with combined infection group,of which 66 strains were Candida albicans,accounting for 64.71%;30 strains were Candida glabrata,accounting for 29.41%;14 strains were Candida tropicalis,accounting for 13.73%;9 strains were Mucor,accounting for 8.82%;and 7 strains were Candida krusei,accounting for 6.86%.The levels of serum presepsin and Hepcidin-25 in the combined infection group and COPD group were higher than those of the control group(P<0.05),and the levels of serum presepsin and Hepcidin-25 in the combined group were higher than those of the COPD group(P<0.05).Univariate analysis showed that the proportion of smoking,two or more fungal infections,and two or more organ failures in the death group,and the levels of presepsin and Hepcidin-25 in peripheral blood were higher than those in the survival group(P<0.05).The difference of the survival curve in patients with the high presepsin group and low presepsin group was statistically significant(P<0.05).Similarly,there was a statistically significant difference in the survival curve of patients in the high Hepcidin-25 group and the low Hepcidin-25 group(P<0.05).COX multivariate analysis showed that smoking,two or more fungal infections,two or more organ failures,peripheral blood presepsin≥245.65 pg/mL,and Hepcidin-25≥38.31 ng/mL were risk factors for death among elderlyCOPD patients with lung fungal infections(P<0.05).Conclusion The distribution of fungi in elderly COPD patients with pulmonary fungal infections is more common with Candida albicans infection.The abnormally high expression of serum presepsin and Hepcidin-25 in elderly COPD patients with pulmonary fungal infection is an independent risk factor affecting death in elderly COPD patients with a pulmonary fungal infection,and changes in their levels have a high predictive value for the prognosis of patients.