老年慢性阻塞性肺疾病急性加重期患者合并肺部真菌感染的特征及预后

Clinical Characteristics and Prognostic of Pulmonary Fungal Infectionin in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:探讨老年慢性阻塞性肺疾病急性加重期(AECOPD)患者合并肺部真菌感染的临床特征及预后。方法:选取2020年3月至2023年3月厦门大学附属第一医院收治的220例老年AECOPD患者为研究对象,统计老年AECOPD患者合并肺部真菌感染的病例数,计算肺部真菌感染发生率,统计病原菌分布情况和患者的临床特征,并将患者分为感染组和未感染组,比较两组患者的预后差异。结果:220例AECOPD患者继发肺部真菌感染46例,发生率为20.91%;共分离出72株真菌菌株,其中白假丝酵母菌和热带假丝酵母菌为主要菌株。46例肺部真菌感染患者胸部计算机断层扫描(CT)主要特征为结节晕轮征、结节影、团块影、空洞等;临床症状表现主要为呼吸困难、发热、咳嗽咳痰、胸痛、干咳、肺部啰音等。治疗后随访6个月,感染组患者的再住院率、病死率均高于未感染组,差异具有统计学意义(P<0.05)。结论:老年AECOPD患者继发肺部真菌感染,主要致病菌为白假丝酵母菌和热带假丝酵母菌,且患者CT特征为结节晕轮征、结节影、团块影、空洞,临床症状表现为呼吸困难、发热、咳嗽咳痰、胸痛、干咳、肺部啰音等,且合并肺部真菌感染会影响患者的预后效果。

Objective To explore the clinical characteristics and prognosis of pulmonary fungal infection in elderly patients with acute exacerbation of chronic obstructivepulmonary disease (AECOPD). Methods A total of 220 elderly AECOPD patients admitted to the First Affiliated Hospital of Xiamen University from March 2020 to March 2023 were selected as the research subjects. The number of cases of pulmonary fungal infection in elderly AECOPD patients was counted, the incidence of pulmonary fungal infection was calculated, the distribution of pathogens and clinical characteristics of patients were analyzed, and patients were divided into infected and uninfected groups. The prognosis differences between the two groups of patients were compared. Results Pulmonary fungal infection occurred in 46 of 220 AECOPD patients (20.91%). A total of 72 fungal strains were isolated, of which Candida albicans and Candida tropicalis were the main strains. The main features of chest computed tomography (CT) in 46 patients with pulmonary fungal infection were nodular halo sign, nodular shadow, mass shadow, cavity, etc. The main clinical symptoms were dyspnea, fever, cough and sputum, chest pain, dry cough, lung rales and so on. Follow-up 6 months after treatment, the re-hospitalization rate and fatality case rate of infected group were higher than those of the uninfected group, the difference was statistically significant (P < 0.05). Conclusion Elderly AECOPD patients develop secondary pulmonary fungal infections, mainly caused by Candida albicans and Candida tropicalis. The CT features of the patients include nodular halo sign, nodular shadow, mass shadow, and cavity. The clinical symptoms include difficulty breathing, fever, cough and sputum, chest pain, dry cough, and lung rales, and the combination of pulmonary fungal infections can affect the prognosis of the patients.