类风湿关节炎住院患者肺部感染的影响因素及病原学特征分析

Analysis of Influencing Factors and Pathogenic Characteristics of Pulmonary Infection in Hospitalized Patients with Rheumatoid Arthritis

目的:研究类风湿关节炎(rheumatoid arthritis,RA)住院患者肺部感染的影响因素及病原学特征。方法:回顾性分析2021年1月—2023年1月北京大学首钢医院收治的118例RA患者的临床资料,以是否存在肺部感染将患者分为观察组(存在肺部感染,n=14)和对照组(不存在肺部感染,n=104)。分析两组一般资料,对RA患者合并肺部感染的影响因素进行分析,并分析观察组病原学特征。结果:观察组年龄、吸烟比例高于对照组,病程长于对照组,差异有统计学意义(P<0.05);观察组糖尿病比例、慢性肺部疾病比例、白细胞计数(white blood cell,WBC)水平、C反应蛋白(C-reactive protein,CRP)水平、糖皮质激素比例高于对照组,血小板计数(platelet,PLT)水平、白蛋白(Albumin,ALB)水平、改善病情风湿药物(disease modifying anti-rheumatic drugs,DMARDs)比例低于对照组,差异有统计学意义(P<0.05);logistic分析结果显示,病程、糖皮质激素是RA患者发生肺部感染的危险因素,DMARDs是RA患者发生肺部感染的保护因素(P<0.05);观察组共检测病原菌10株,其中革兰阳性菌3株(30.00%)、革兰阴性菌6株(60.00%)、真菌1株(10.00%)。结论:病程、糖皮质激素药物是RA住院患者发生肺部感染的危险因素,而DMARDs则是RA患者发生肺部感染的保护因素;RA住院患者肺部感染的病原菌类型涉及革兰阳性菌、革兰阴性菌、真菌多种类型。

Objective:To study the influencing factors and pathogenic characteristics of pulmonary infection in hospitalized patients with rheumatoid arthritis(RA).Method:The clinical data of 118 patients with RA who admitted to Shougang Hospital of Peking University from January 2021 to January 2023 were retrospectively analyzed,the patients were divided into the observation group(with pulmonary infection,n=14)and the control group(without pulmonary infection,n=104)according to the presence or absence of pulmonary infection.The general data of two groups were analyzed,the influencing factors of RA patients with pulmonary infection were analyzed,and the pathogenic characteristics of the observation group were analyzed.Result:The age and smoking proportion of the observation group were higher than those of the control group,and the disease course was longer than that of the control group,the differences were statistically significant(P<0.05);the diabetes proportion,chronic lung disease proportion,white blood cell count(WBC)level,C-reactive protein(CRP)level and glucocorticoid proportion in the observation group were higher than those in the control group,while the platelet count(PLT)level,albumin(ALB)level and disease modifying anti-rheumatic drugs(DMARDs)in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05);the results of logistic analysis showed that the course of disease and glucocorticoids were risk factors for pulmonary infection in RA patients,while DMARDs was protective factors for pulmonary infection in RA patients(P<0.05);a total of 10 strains of pathogenic bacteria were detected in the observation group,including 3 strains(30.00%)of gram-positive bacteria,6 strains(60.00%)of gram-negative bacteria and 1 strain(10.00%)of fungi.Conclusion:At the same time,the course of disease and glucocorticoid drugs are risk factors for pulmonary infection in RA inpatients,while DMARDs is protective factors for pulmonary infection in RA patients.The pathogenic types of pulmonary infection in RA inpatients involve various types of Gram positive bacteria,Gram negative bacteria,and fungi.