院内获得性念珠菌血症的临床特征及其影响因素  

Clinical characteristics and influencing factors of nosocomial candidemia

作　　者：钟雪锋[1] 居阳[1] 蒲纯[1] 李燕明[1] 孙铁英[1] 

机构地区：[1]卫生部北京医院呼吸与危重症医学科,100730

出　　处：《中华医学杂志》2015年第18期1386-1390,共5页National Medical Journal of China

基　　金：国家科技支撑计划（2102BA105800）

摘　　要：目的 分析院内获得性念珠菌血症的临床特征及影响因素.方法 纳入北京医院2006年1月1日至2011年12月31日血培养念珠菌阳性病例,收集一般资料、基础疾病及危险因素、临床特征及实验室检查数据.分组比较死亡组（住院期间死亡）比存活组（住院期间存活）及白色念珠菌组比非白色念珠菌组相应的临床特征、影响预后的危险因素、影响念珠菌血症病原分布的危险因素.结果 纳入白色念珠菌血症患者30例,非白色念珠菌血症患者35例.平均年龄（76±14）岁,总住院病死率为58.5％（38/65）.死亡组急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、APACHEⅡ评分＞24分比率、休克发生率、发病距离确诊时间、血清白蛋白≤30 g/L比率分别为（28.7±8.6）分、55.3％（21/38）、71.1％（27/38）、（138.7 ±50.4）h、47.4％（18/38）,均显著大于存活组的（20.1±8.0）分、29.6％（8/27）、44.4％（12/27）、（127.2 ±50.2）h、22.2％（6/27）（均P＜0.05）.Logistic多因素回归分析显示休克（OR=4.821,P=0.030）、发病距确诊时间（OR=1.594,P=0.027）、APACHEⅡ评分（OR=1.096,P=0.032）为患者死亡的独立危险因素;持续血液净化治疗为降低死亡的因素（OR=0.014,P=0.004）,糖尿病是非白色念珠菌血症的独立危险因素（OR=4.426,P =0.016）.结论 念珠菌血症患者具有高龄、基础疾病多、病情重、病死率高等临床特点.休克、APACHEⅡ评分、发病距确诊时间是念珠菌血症死亡独立危险因素;持续血液净化治疗为念珠菌血症存活的保护性因素.糖尿病是非白色念珠菌血症的独立危险因素。Objective To retrospectively explore the clinical features and risk factors of nosocomially acquired candidemia.Methods Retrospective analyses were conducted for general information,underlying diseases,risk factors,clinical features and laboratory tests of blood culture Candidapositive cases at Beijing Hospital from January 1,2006 to December 31,2011.Comparisons were made with regards to the clinical features,prognostic factors,risk factors of candidemia pathogen distribution between dead and survival groups and Candida albicans vs non-Candida albicans groups.Statistical analysis was performed with SPSS 19.0.Results A total of 30 Candida albicans and 35 non-candida albicans cases were recruited.Their mean age was （76 ± 14） years and total in-hospital fatality rate 58.5% （38/65）.The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score,ratio of APACHE Ⅱ score 〉24 points,ratio of shock,primary diagnosis time （from onset to reporting time of positive outcome of blood culture） and ratio of serum albumin ≤30 g/L of death group were （28.7 ±8.6） score,55.3% （21/38）,71.1% （27/38）,（138.7 ± 50.4） h,47.4% （18/38） respectively.And the values were significantly higher than those of survival group,i.e.（20.1 ± 8.0） score,29.6% （8/27）,44.4% （12/27）,（127.2±50.2） h and 22.2% （6/27） respectively.Multivariate Logistic regression analysis showed that shock （OR =4.821,P =0.030）,primary diagnosis time （OR =1.594,P =0.027） and APACHE Ⅱ score （OR =1.096,P =0.032） were independent risk factors for death.However continuous blood purification therapy was an independent protective factor （OR =0.014,P =0.004）.And diabetes was an independent risk factors for non-Candida albicans infection （OR =4.426,P =0.016）.Conclusions Advanced age,more underlying diseases,severe clinical conditions and high fatality rate are the major clinical characteristics of candidemia.Shock,APACHE Ⅱ score and primary diagnosis time are independent risk factors for

关 键 词：念珠菌病 念珠菌 白色 疾病特征 危险因素 

分 类 号：R519.3[医药卫生—内科学]