慢性阻塞性肺疾病患者肺部真菌感染危险因素研究  

Risk factors for pulmonary fungal infections in patients with chronic obstructive pulmonary disease

作　　者：龚峰[1] 叶瑞海[1] 林海[1] 

机构地区：[1]瑞安市人民医院呼吸内科,浙江瑞安325200

出　　处：《中华医院感染学杂志》2014年第13期3237-3239,共3页Chinese Journal of Nosocomiology

基　　金：温州市医药卫生科研基金资助项目(2006B055)

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)患者继发医院肺部真菌感染及其危险因素,为临床治疗提供可靠的依据。方法回顾性分析2009年1月-2012年6月725例COPD患者的临床资料,对真菌感染患者危险因素进行分析;采用SPSS19.0软件对资料进行统计分析。结果 725例COPD患者中有56例发生肺部真菌感染感染率7.7%,共检出真菌83株,检出白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌、克柔假丝酵母菌、近平滑假丝酵母菌、毛霉菌属、曲霉菌属、葡萄牙假丝酵母菌,分别占60.24%、13.25%、6.02%、4.82%、7.23%、3.61%、2.41%、1.21%;真菌对制菌霉素、两性霉素B、伊曲康唑较敏感,对氟胞嘧啶、酮康唑及咪康唑的敏感性较差;低白蛋白血症、使用肾上腺糖皮质激素>500mg、广谱抗菌药物使用时间>14d、合并呼吸衰竭是COPD患者发生肺部真菌感染的独立危险因素(P<0.05)。结论提高对COPD患者继发肺部真菌感染危险因素的认识,有针对性地采取防治措施,可以减少肺部真菌感染的发生。OBJECTIVE To explore the risk factors for secondary pulmonary fungal infections in patients with chro- nic obstructive pulmonary disease （COPD） so as to provide reliable guidance for clinical treatment. METHODS The clinical data of 725 COPD patients who were treated in the hospital from Jan 2009 to Jun 2012 were retrospectively analyzed, then the risk factors for the fungal infections were analyzed, and the statistical analysis of data was per- formed with the use of SPSS19.0 software. RESULTS Of the 725 COPD patients, the pulmonary fungal infections occurred in 56 cases with the infection rate of 7.7%. A total of 83 strains of fungi have been isolated, among which Candida albicans accounted for 60.24%, Candida tropicalis 13.25%, Candida glabrata 6.02%, Candi- da krusei 4. 82%, Candida paraosilosi 7. 23N, Mucor 3. 61%, Penicillium 2. 41%, Aspergillus rumigutus 1.21%. The isolated fungi were susceptible to nystatin, amphotericin B, and itraeonazole but were less susceptible to 5-fluorocytosine, ketoeonazol, and miconazole. The hypoalbuminemia, use of glucoeorticoid more than 500 mg, time of use of broad-spectrum antimierobial agents more than 14 days, and complication of respiratory failure were the independent risk factors for the pulmonary fungal infections in the COPD patients （P〈0.05）. CONCLUSION It is an effective way to improve the awareness of the risk factors for the secondary pulmonary fungal infections in the COPD patients and take targeted prevention measures so as to reduce the incidence of pulmonary fungal infections.

关 键 词：慢性阻塞性肺疾病 真菌 感染 危险因素 

分 类 号：R563[医药卫生—呼吸系统]