肺癌145例化疗后并发下呼吸道感染影响因素分析

Analysis of influencing factors of lower respiratory tract infection after chemotherapy for 145 cases of lung cancer

目的分析肺癌化疗后并发下呼吸道感染的影响因素。方法选择2020年10月至2021年10月重庆市第十三人民医院收治的肺癌化疗病人145例,依据病人下呼吸道感染监测结果分成并发下呼吸道感染组(n=44)与无下呼吸道感染组(n=101),用logistic回归分析影响肺癌化疗后并发下呼吸道感染风险的危险因素。结果44例肺癌化疗后并发下呼吸道感染病人共培养分离病原菌48株,包括革兰阴性菌(31株,64.58%)、革兰阳性菌(13株,27.08%)、真菌(4株,8.33%)。肺癌化疗后并发下呼吸道感染组与无下呼吸道感染组在合并慢性阻塞性肺疾病(COPD,36.36%比19.8%)、合并其他疾病(18.18%比5.94%)、第1秒用力呼气容积占预计值百分比(FEV1.0%)[(73.04±20.32)%比(90.27±18.74)%]、吸烟史(81.82%比66.34%)、非小细胞肺癌占比(65.91%比68.32%)、化疗周期>2次占比(86.36%比49.50%)、侵入性操作占比(86.36%比51.49%)、中性粒细胞缺乏(63.64%比43.56)、CD4+/CD8+≤1占比(84.09%比45.54%)、预防使用抗菌药物(22.73%比76.24%)、住院时间>20 d占比(70.45%比51.49%)方面比较,差异有统计学意义(P<0.05)。logistic回归分析结果显示:化疗周期>2次、侵入性操作>2次、CD4+/CD8+≤1、未预防使用抗菌药物均是影响肺癌化疗后并发下呼吸道感染的危险因素(P<0.05)。结论肺癌化疗病人易并发下呼吸道感染,建议积极有效控制化疗周期>2次、侵入性操作>2次、CD4+/CD8+≤1、未预防使用抗菌药物等多项危险因素。

Objective To analyze the influencing factors of lower respiratory tract infection after lung cancer chemotherapy.Methods From October 2020 to October 2021,145 lung cancer chemotherapy patients admitted to Chongqing 13th People's Hospital were selected and divided into a lower respiratory tract infection group(n=44)and nonlower respiratory tract infection group(n=101)according to the monitoring results of lower respiratory tract infection.Logistic regression was used to analyze the risk factors that affected the risk of lower respiratory tract infection after lung cancer chemotherapy.Results A total of 48 pathogenic bacteria were cultured and isolated from 44 patients with lower respiratory tract infection complicated by lung cancer chemotherapy,including gram-negative bacteria(31 strains,64.58%),gram-positive bacteria(13 strains,27.08%)and fungi(4 strains,8.33%).The group with lung cancer chemotherapy complicated by lower respiratory tract infection compared with the group without lower respiratory tract infection had a higher rate of lower respiratory tract infection than the group with combined COPD(36.36%vs.19.8%),combined other diseases(18.18%vs.5.94%),FEV1.0%[(73.04±20.32)%vs.(90.27±18.74)%],history of smoking(81.82%vs.66.34%),non-small cell lung cancer(65.91%vs.68.32%),chemotherapy cycles>2(86.36%vs.49.50%),invasive operations(86.36%vs.51.49%),neutrophil deficiency(63.64%vs.43.56),CD4^(+)/CD8^(+)≤1(84.09%vs.45.54%),prophylactic use of antimicrobial drugs(22.73%vs.76.24%),and length of stay>20 d as a percentage(70.45%vs.51.49%)were significantly different(P<0.05).Logistic regression analysis showed that chemotherapy cycles>2,invasive operations>2,CD4^(+)/CD8^(+)≤1,and failure to use antimicrobial drugs prophylactically were all risk factors affecting the complication of lower respiratory tract infections after chemotherapy for lung cancer(P<0.05).Conclusion Patients with lung cancer who undergo chemotherapy are prone to lower respiratory tract infection,and several risk factors such as>2 chemotherapy cycles,invasive operations>2,CD4^(+)/CD8^(+)≤1,and unprevented use of antimicrobial drugs are recommended to be actively and effectively controlled.