重症肺炎发生肺部真菌感染的危险因素

Risk factors of pulmonary fungal infection in patients with severe pneumonia

目的探讨重症肺炎患者发生肺部真菌感染的危险因素。方法本研究为回顾性队列研究,采用非随机抽样的方法收集所有2021年1月1日至12月31日重庆医科大学附属第一医院呼吸与危重症医学科ICU的重症肺炎患者151例,根据住院期间是否发生真菌感染分为真菌感染组(78例)和无真菌感染组(73例),收集患者入院前的基线资料、住院时间和住ICU时间,比较2组症状、外科手术史、CT影像特征、中性粒细胞计数、淋巴细胞计数、中性粒细胞计数和淋巴细胞计数比值(NLR)、白细胞介素6(IL-6)、IL-8和降钙素原(PCT)、总T细胞CD3+和白蛋白,采用logistic回归分析肺部真菌感染的危险因素。结果真菌感染组患者住院时间和住ICU时间均较无真菌感染组长,分别为[13.5(8.0,22.0)]d比[9.0(6.0,13.0)]d和[10.0(5.0,16.3)]d比[7.0(4.0,9.0)]d,差异均有统计学意义(Z值分别为2.69、2.98;均P<0.05)。真菌感染组合并发热和有外科手术史者的比例较无真菌感染者高,分别为53.8%(42/78)比46.6%(34/73)和16.7%(13/78)比2.7%(2/73),差异均有统计学意义(χ2值分别为5.87、8.18;均P<0.05)。真菌感染组中性粒细胞计数、PCT、NLR的峰值、IL-6、IL-8均较无真菌感染组高;总T细胞CD3+和白蛋白较无真菌感染组低,分别为中性粒细胞计数峰值[12.43(8.77,17.07)]×10^(9)/L比[9.22(6.30,15.34)]×10^(9)/L;PCT峰值[1.94(0.26,11.02)]mg/L比[0.47(0.14,3.49)mg/L;NLR峰值[25.24(12.39,45.49)]比[13.49(6.43,28.58)];IL-6[26.55(6.58,156.98)]ng/L比[13.73(1.87,60.93)]ng/L;IL-8[5.13(0.81,34.12)]ng/L比[1.73(0.37,7.85)]ng/L;总T细胞CD3+[0.47(0.25,0.73)]×10^(9)/L比[0.69(0.28,0.96)]×10^(9)/L;白蛋白[27.00(24.00,30.00)]g/L比[30.00(27.00,35.00)]g/L;差异均有统计学意义(Z值分别为2.42、2.82、3.07、2.44、2.09、2.25、4.33,均P<0.05)。logistic回归分析结果显示:入院前3个月内有外科手术史(OR=9.206,P=0.009)、入院时IL-8>3.734 ng/L(OR=1.955,P=0.042)、入院时白蛋白≤28 g/L(OR=3.833,P<0.001)是重症肺炎合并真菌感染的危险因素。结论患者入院前3个月有外科手术史、入院时IL-8>3.734 ng/L、入院时白蛋白≤28 g/L是重症肺炎患者发生肺部真菌感染的危险因素。

Objective To explore the risk factors of pulmonary fungal infection in patients with severe pneumonia.Methods This was a retrospective cohort study.Non-random sampling method was used.Based on the inclusion and exclusion criteria,were enrolled 151 patients with severe pneumonia admitted to the intensive care unit of the First Affiliated Hospital of Chongqing Medical University from January 1,2021,to December 31,2021 were enrolled.The patients were divided into fungal infection group(78 cases)and non-fungal infection group(73 cases)according to the appearance of pulmonary fungal infection during hospitalization.The data,including demographic characteristics and the hospital and ICU length of stay were collected.The symptoms,history of surgery,chest CT imaging,neutrophil,lymphocyte,neutrophil/lymphocyte rate,IL-6,IL-8,procalcitonin(PCT),NLR,CD3+T cells,and albumin between the two groups were statistically analyzed.Logistic regression analysis was used to determine the risk factors.Results Fungal infection group showed longer hospital and ICU length of stay than non-fungal infection group,with the results of(13.5[8.0,22.0])d vs(9.0[6.0,13.0])d and(10.0[5.0,16.3])d vs(7.0[4.0,9.0])d,and differences are statistically significant(Z=2.69,2.98;P<0.05).Higher rate of having fever and history of surgery were also observed in fungal infection group,with the results of 53.8%(42/78)vs 46.6%(34/73)and 16.7%(13/78)vs 2.7%(2/73),and all differences are also statistically significant(χ^(2)=5.87,8.18;P<0.05).After analysis,the peak of neutrophil,PCT,and NLR,IL-6,and IL-8 were significantly higher while CD3+T cells and albumin were lower in fungal infection patients,with the results of neutrophil(12.43[8.77,17.07])×10^(9)/L vs(9.22[6.30,15.34])×10^(9)/L,PCT(1.94[0.26,11.02])mg/L vs(0.47[0.14,3.49])mg/L,NLR(25.24[12.39,45.49])vs(13.49[6.43,28.58]),IL-6(26.55[6.58,156.98])ng/L vs(13.73[1.87,60.93])ng/L,IL-8(5.13[0.81,34.12])ng/L vs(1.73[0.37,7.85])ng/L,CD3+T cells(0.47[0.25,0.73])×10^(9)/L vs(0.69[0.28,0.96])×10^(9)/L,albumin(27.00,[24.00,30.00])g/L vs(30.00[27.00,35.00])g/L;and all differences are statistically significant(Z=2.42,2.82,3.07,2.44,2.09,2.25,and 4.33,P<0.05).Multivariate logistic regression analysis showed that history of surgery 3 months before hospitalization(OR=9.206,P=0.009),IL-8>3.70 ng/L(OR=1.955,P=0.042),and albumin≤28 g/L(OR=1.955,P=0.042)are risk factors of severe pneumonia combined with fungal infection.Conclusions Surgery history 3 months before hospitalization,IL-8>3.8 ng/L and albumin≤28 g/L are the risk factors of severe pneumonia combined with fungal infection.