慢性阻塞性肺疾病急性加重期继发真菌感染的临床相关因素分析  

Risk factors for secondary fungal infections in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：石卫霞 林英翔[2] 梁立荣[2] 朱建国[3] 

机构地区：[1]北京市顺义区妇幼保健院,北京101300 [2]首都医科大学附属北京朝阳医院北京市呼吸疾病研究所北京市呼吸与肺循环疾病实验室,北京100020 [3]卫生部北京医院老年医学研究所,北京100730

出　　处：《中华医院感染学杂志》2014年第17期4243-4244,4247,共3页Chinese Journal of Nosocomiology

基　　金：北京市科学技术委员会首都临床特色应用研究基金资助项目(Z111107058811002);卫生部卫生公益性行业科研专项基金项目(201002008)

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)急性加重期继发真菌感染的危险因素、临床特征,为肺部真菌感染的早期预防和诊断提供临床依据。方法回顾性分析2011年1-12月收治的794例COPD急性加重期住院患者的临床资料。结果 794例患者中继发真菌感染140例,感染率17.63%;140例真菌感染患者检出白色假丝酵母菌占36.43%,曲霉菌属占21.43%;高龄、住院时间长、合并多种其他基础疾病(糖尿病)、既往侵袭性真菌感染病史、低蛋白血症、长期住ICU,长时间体内留置导管、有创机械通气以及广谱抗菌药物使用为继发真菌感染的重要危险因素;好转及痊愈117例占83.57%,无效10例占7.14%,死亡13例,病死率9.29%。结论 COPD继发真菌感染病死率较高,对于高危人群进行有效治疗、合理使用广谱抗菌药物和糖皮质激素、减少侵入性操作、重视病原学标本的采集,做出早期诊断并及时抗真菌治疗,可改善预后、降低病死率。OBJECTIVE To explore the risk factors for secondary fungal infections in pauents with, acute exacerbation of chronic obstructive pulmonary disease （COPD） and analyze the clinical characteristics so as to provide guidance for early prevention and diagnosis of pulmonary fungal infections. METHODS A total of 794 patients with acute exacerbation of COPD who were treated in the hospital from Jan to Dec 2011 were enrollecl in the study, then the clinical data of the patients were retrospectively analyzed. RESULTS The secondary fungal infections occurred in 140 of 794 patients, with the infection rate of 17.63%. The Candida alblcans strains that were isolated from the 140 patients with fungal infections accounted for 36.43%, the Aspergillus21.43%. The major risk factors for the secondary fungal infections included the advanced age, long length of hospital stay, complication of multiple underlying diseases （diabetes）, history of invasive fungal infections, hypoalbuminemia, long ICU stay, long-term catheter indwelling time, invasive mechanical ventilation, and use of broad spectrum antibiotics. Totally 117 （83.57%） patients were improved or cured, 10 （7.14%） patients ineffective, and 13 patients died, with the mortality rate of 9.29%. CONCLUSION The mortality rate of the COPD patients complicated with secondary fungal infections is high. It is an effective way to perform targeted treatment for the high-risk population, reasonably use broad spectrum antibiotics and glucocorticoids, reduce invasive procedures, pay attention to the collection of species for etiology, make early diagnosis, and carry out timely anti-fungal therapy so as to improve the prognosis and reduce the mortality rate.

关 键 词：慢性阻塞性肺疾病 真菌 危险因素 

分 类 号：R563[医药卫生—呼吸系统]