慢性肾脏病患者血液透析期间肺部感染病原菌及危险因素

Pathogens and risk factors for pulmonary infection during hemodialysis in patients with chronic kidney disease

目的探讨慢性肾脏病(CKD)患者血液透析期间肺部感染(PI)的病原菌分布特点与相关危险因素.方法研究对象选自于2018年5月—2022年11月在江南大学附属医院接受治疗的CKD患者,共纳入106例,并对其临床资料进行回顾性分析,根据所选患者血液透析期间是否发生PI将其分为感染组(27例)和未感染组(79例);统计感染组患者病原菌分布特点,比较两组临床资料,CKD患者血液透析期间PI的危险因素予以多因素Logistic回归分析法进行分析.结果感染组27例患者共检出病原菌13株,检出率为48.15%,革兰阳性菌2株,革兰阴性菌7株,真菌4株;感染组心功能分级为Ⅳ级、合并糖尿病、心衰的患者占比分别为44.44%、48.15%、51.85%,均高于未感染组的22.78%、26.58%、30.38%(P<0.05);感染组外周血血红蛋白水平<110 g/L的患者占比为62.96%,均高于未感染组的40.51%;外周血白细胞水平及红细胞分布宽度高于未感染组,血清磷水平低于未感染组(P<0.05);采用多因素Logistic回归分析法分析结果显示,CKD患者血液透析期间PI的危险因素包括合并糖尿病、合并心衰(OR=3.658、2.680,P<0.05).结论CKD患者血液透析期间PI的危险因素包括合并糖尿病、合并心衰,且感染病原菌中革兰阴性菌占比较高,主要为肺炎克雷伯菌,临床可据此给予针对性的预防措施及抗菌治疗.

OBJECTIVE To explore the distribution characteristics of pathogenic bacteria and related risk factors of pulmonary infection(PI)in patients with chronic kidney disease(CKD)during hemodialysis.METHODS Patients with CKD who received treatment at Affiliated Hospital of Jiangnan University from May 2018 to Nov 2022 were enrolled.A total of 106 cases were included and their clinical data were retrospectively analyzed.The patients were divided into the infected group(27 cases)and the non-infected group(79 cases)according to whether PI occurred during hemodialysis.The characteristics of pathogenic distribution in patients of the infection group were analyzed and the clinical data between the two groups were compared.The risk factors of PI in patients with CKD during hemodialysis were analyzed by multivariate logistic regression analysis.RESULTS A total of 13 strains of patho-genic bacteria were detected in 27 patients of the infection group,with a detection rate of 48.15%.There were two strains of gram-positive bacteria,seven strains of gram-negative bacteria and 4 strains of fungal.The proportion of patients with gradeⅣheart function,diabetes and heart failure in the infected group was 44.44%,48.15%and 51.85%,respectively,which were higher than 22.78%,26.58%and 30.38%in the uninfected group(P<0.05).The proportion of infected patients with the level of peripheral blood hemoglobinx<110 g/L was 62.96%,which were higher than 40.51%in the non-infected group.The levels of peripheral blood leukocyte and red blood cell distribution width were higher than those in the non-infected group.The serum phosphorus level was lower than that in the non-infected group(P<0.05).Multifactor logistic regression analysis showed that the risk factors for PI in CKD patients during hemodialysis included diabetes and heart failure(OR=3.658,2.680,P<0.05).CONCLUSION The risk factors of PI in CKD patients during hemodialysis include combination of diabetes and heart failure.And gram-negative bacteria account for a high proportion of infection pathogens,mainly Klebsiella pneumoniae.Therefore,targeted preventive measures and antibacterial treatment could be given clinically.