结构性肺病合并侵袭性肺曲霉病40例临床分析

Clinical analysis of 40 cases of structural lung disease complicated with invasive pulmonary aspergillosis

目的探讨结构性肺病合并侵袭性肺曲霉病(IPA)的发病危险因素及临床特点。方法收集福建省立医院各科室2008年1月至2021年12月期间住院治疗的40例结构性肺病合并IPA患者作为感染组,采用1:2配对病例对照分析法,选取同期住院、且年龄和性别一致的患有同种结构性肺病未合并IPA的80例患者作为对照组。回顾性分析感染组和对照组的临床资料,运用单因素和多因素的条件Logistic回归分析危险因素。结果感染组患者中以烟曲霉感染最常见(80.0%);感染组患者在咯血、合并Ⅱ型呼吸衰竭、新发空洞、空气新月征方面的比例明显高于对照组,差异均有统计学意义(P<0.05);单因素分析显示,感染组患者在合并G-菌感染、急性心力衰竭、急性肾衰竭、营养不良、住院天数>14 d、长期卧床、入住ICU、机械通气、联合使用>2种广谱抗生素、抗生素使用大于14 d、使用抗铜绿假单胞菌抗生素、3个月内使用氟康唑、感染前3个月糖皮质激素使用总剂量>700 mg、使用糖皮质激素超过3周的比例和对照组比较差异均有统计学意义(P<0.05);多因素条件Logistic回归分析显示,广谱抗生素使用超过2种、合并G^(-)菌感染、住院时间>14 d、感染前3个月糖皮质激素使用总剂量>700 mg是IPA发生的独立危险因素(P<0.05)。结论结构性肺病合并IPA患者以咯血、合并呼吸衰竭、肺内新发空洞、空气新月征为特征,长期住院、多种广谱抗生素联合使用、合并G-菌感染、长期全身大剂量使用糖皮质激素可增加IPA发生风险。

Objective To investigate the risk factors and clinical features of structural lung disease complicated with invasive pulmonary aspergillosis(IPA).Methods A total of 40 inpatients with structural pulmonary disease complicated with IPA from January 2008 to December 2021 in Fujian Provincial Hospital were collected as infection group.Based on 1:2 matched case-control study method,80 inpatients of the same age and gender with the same structural lung disease without IPA were selected as the control group.The clinical data of the infection group and the control group were retrospectively analyzed,and the risk factors were analyzed by univariate and multivariate conditional Logistic regression.Results Aspergillus fumigatus was the most common in the infection group(80.0%).The proportions of hemoptysis,complication with typeⅡrespiratory failure,new cavity,air crescent sign were significantly higher in the infection group that in the control group(P<0.05).Univariate analysis showed that there were statistically significant difference between the two groups in the proportion of G-bacterial infection,acute heart failure,acute renal failure,malnutrition,length of hospital stay>14 days,ICU admission,lying in bed,mechanical ventilation,combined use of>2 broad-spectrum antibiotics,antibiotic use for more than 14 days,use of anti-pseudomonas aeruginosa antibiotics,use of fluconazole within 3 months,total dose of glucocorticoid used in 3 months before infection>700 mg,and glucocorticoid use for more than 3 weeks(P<0.05).Multivariate logistic regression analysis showed that combined use of>2 broad-spectrum antibiotics,complication with G^(-) bacterium infection,length of hospital stay>14 d,total dose of glucocorticoid used in 3 months before infection>700 mg were the independent risk factors for IPA.Conclusion Patients with structural lung disease complicated with IPA are characterized by hemoptysis,respiratory failure,new cavities in the lung,and air crescent sign.Long-term hospitalization,combined use of more than two kinds of broad-spectrum antibiotics,G-bacterium infection,and long-term systemic high-dose use of glucocorticoids can increase the risk of IPA.