肺癌患者合并肺部真菌感染的危险因素及其耐药性的Meta分析

Meta-analysis on risk factors for combined pulmonary fungal infections and their drug resistance in patients with lung cancer

目的系统评价肺癌患者合并肺部真菌感染危险因素及其耐药性.方法利用计算机检索维普(VIP)、万方数据库、中国知网(CNKI)、Web of Science及PubMed数据库,收集有关肺癌合并肺部真菌感染的危险因素及耐药相关的横断面研究,检索2012年1月—2022年12月刊登的文献.对文献进行质量评价与资料提取,使用R Studio软件进行Meta分析.结果纳入13篇文献,包括4157名患者,其中肺部真菌感染者837名,真菌感染率为20.13%;促进患者发生真菌感染的危险因素及OR值分别为年龄>65岁(OR=3.28,95%CI:1.04~10.28,P<0.01),吸烟(OR=2.22,95%CI:1.25~3.93,P<0.01),患有糖尿病(OR=2.62,95%CI:1.33~5.15,P=0.03),住院时间≥2周(OR=3.61,95%CI:1.58~8.26,P<0.01),使用广谱抗菌药物(OR=1.91,95%CI:1.50~2.44,P<0.01),使用激素(OR=2.22,95%CI:1.69~2.91,P<0.01),放化疗(OR=2.12,95%CI:1.70~2.64,P<0.01);肺部真菌感染的常见前1~5名最易感染的真菌分别为白假丝酵母、热带假丝酵母、光滑假丝酵母、克柔假丝酵母及曲霉菌;毛霉菌、克柔假丝酵母、光滑假丝酵母对氟康唑、伊曲康唑及伏立康唑耐药率较高,两性霉素B和氟胞嘧啶对各真菌耐药率较低.结论肺癌患者合并真菌感染较为普遍,年龄、吸烟、患有糖尿病、住院时间≥2周、使用广谱抗菌药物、使用激素、放化疗均为肺癌患者合并肺部真菌感染的危险因素、医院在真菌用药方面优先考虑氟胞嘧啶和两性霉素B.

OBJECTIVE To systematically evaluate the risk factor of combined pulmonary fungal infections,and their drug resistance in lung cancer patients.METHODS Cross-sectional studies related to risk factors and drug re-sistance associated with pulmonary fungal infections in lung cancer were collected using computer searches of VIP,Wanfang database,CNKI,Web of Science,and PubMed databases,and literatures published from Jan.2012 to Dec.2022 was searched.The literature was evaluated for quality and information was extracted,and Meta-analy-sis was performed using R Studio software.RESULTS A total of 13 studies were included,including 4157 pa-tients,of whom 837 had pulmonary fungal infection,with a fungal infection rate of 20.13%.The risk factors and ORs(Odds Ratio)promoting the development of fungal infections in patients were age>65 years(OR=3.28,95%CI:1.04-10.28,P<0.01),smoking(OR=2.22,95%CI:1.25-3.93,P<0.01),complicated with di-abetes mellitus(OR=2.62;95%CI:1.33-5.1,P=0.03),length of hospital stay no less than two weeks(OR=3.61,95%CI:1.58-8.26,P<0.01),the use of broad-spectrum antibiotics(OR=1.91,95%CI:1.50-2.44,P<0.01),use of hormones(OR=2.22,95%CI:1.69-2.91,P<0.01),radiotherapy and chemotherapy(OR=2.12,95%CI:1.70-2.64,P<0.01).The common top 1-5 most susceptible fungi for pulmonary fungal infections were Candida ablans,Candida tropicalis,Candida glabrata,Candida krusei,and Aspergillus.Mu-cormycosis and Candida krusei were more resistant to fluconazole,ftraconazole and voriconazole,while respective fungi were less resistant to amphotericin B and flucytosine.CONCLUSION Combined fungal infections were more common in lung cancer patients,age,smoking,complicated with diabetes mellitus,length of hospital stay no less than two weeks,the use of broad-spectrum antibiotics,use of hormone and radiotherapy and chemotherapy were all risk factors for combined pulmonary fungal infections in lung cancer patients,and flucytosine and amphotericin B were prioritized for fungal medications in hospitals.