老年2型糖尿病合并肺部侵袭性真菌感染的危险因素

Risk factors for pulmonary invasive fungal infection in elderly patients with type 2 diabetes mellitus

目的分析老年2型糖尿病(T2DM)合并肺部侵袭性真菌感染(PIFI)的危险因素。方法回顾性分析2016年6月-2020年6月重庆市綦江区人民医院收治的200例T2DM老年患者,根据是否合并肺部PIFI分为感染组42例和未感染组158例。无菌采集感染组T2DM老年患者痰液,进行病原菌分离鉴定。记录两组T2DM老年患者年龄、性别、糖尿病病程、糖化血红蛋白(HbA1c)值、抗菌药物使用时间等一般资料。采用二分类Logistic回归分析影响T2DM合并肺部PIFI患者的因素。结果42例T2DM合并肺部PIFI患者共分离病原菌73株,分离菌株以白假丝酵母(69.86%)和热带假丝酵母(12.41%)为主;T2DM患者并发PIFI与患者年龄、糖尿病病程、住院时间、抗菌药物使用时间、HbA1c值和侵入性操作有关(P<0.05);Logistic回归分析,抗菌药物使用时间、HbA1c值≥7%及侵入性操作均为影响T2DM合并肺部PIFI感染老年患者的危险因素(P<0.05)。结论长期使用抗菌药物、HbA1c值≥7%和侵入性操作均为T2DM合并肺部PIFI老年患者的危险因素,临床可重点关注高危患者,并及时给予有效的干预措施。

OBJECTIVE To investigate the risk factors for pulmonary invasive fungal infection(PIFI)in elderly patients with type 2 diabetes mellitus(T2 DM).METHODS A total of 200 elderly patients with T2 DM who were treated in Qijiang District People’s Hospital from Jun 2016 to Jun 2020 were enrolled in the study and divided into the infection group with 42 cases and the no infection group with 158 cases according to the status of PIFI.The sputum specimens were collected from the patients of the infection group by aseptic method,pathogens were isolated and identified.The baseline data of the two groups of patients,including age,gender,course of diabetes mellitus,glycated hemoglobin(HbA1 c)and time of use of antibiotic were recorded.Binary logistic regression analysis was performed for influencing factors for PIFI in the elderly patients with T2 DM.RESULTS Totally 73 strains of pathogens were isolated from 42 T2 DM patients complicated with PIFI,69.86%of which were Candida albicans,and 12.41%were Candida tropicalis.The complication with PIFI in the T2 DM patients was associated with the age,course of diabetes mellitus,length of hospital stay,time of use of antibiotics,HbAlc and invasive operation(P<0.05).Logistic regression analysis showed that long term use of antibiotics,HbAlc value no less than 7%and invasive operation were the risk factors for PIFI in the T2 DM patients(P<0.05).CONCLUSION Long term use of antibiotics,HbAlc no less than 7%and invasive operation are the risk factors for PIFI in the elderly patients with T2 DM.It is necessary for the hospital to pay attention to the high risk patients and take effective intervention measures.