老年COPD患者并发肺部真菌感染危险因素分析  

The risk factors of pulmonary fungal infections in elderly patients with chronic obstructive pulmonary disease

作　　者：靳妮娜[1] 孙炎华[1] 左万里[1] 黄艳芬[1] 刘凌云[1] 余维庆[1] 

机构地区：[1]中山大学附属江门市中心医院呼吸内科,广东529030

出　　处：《中国临床新医学》2015年第7期630-633,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的探索老年慢性阻塞性肺疾病(COPD)患者并发肺部真菌感染的危险因素。方法选取145例老年COPD患者,以并发肺部真菌感染85例为观察组,未并发肺部真菌感染60例为对照组,收集整理两组患者的临床资料,对比分析组间差异;同时行真菌培养及鉴定,统计感染真菌的分布情况。结果与对照组比较,观察组住院时间、吸烟史、抗菌药物使用时间显著增加,血清白蛋白水平显著降低,同时糖皮质激素使用时间≥2周,并发糖尿病、呼吸衰竭、行机械通气的例数显著增加,组间比较差异均具有统计学意义(P<0.01)。多因素回归分析发现,抗菌药物、糖皮质激素的长期使用、低白蛋白血症、并发糖尿病及呼吸衰竭、实施机械通气均是导致老年COPD患者并发肺部真菌感染的高危因素(P<0.05)。真菌感染以假丝酵母菌属为主,其中白色假丝酵母菌检出率最高。结论对于COPD治疗,应合理使用抗菌药物及糖皮质激素,尽量避免侵入性机械通气,同时重视相应并发症的治疗,从而有效避免继发肺部真菌感染。Objective To explore the risk factors of pulmonary fungal infections in elderly patients with chronic obstructive pulmonary disease（ COPD）. Methods 85 COPD patients complicated with pulmonary fungal infections and other 60 COPD patients without pulmonary fungal infections were selected. The clinical data of the two groups were collected and comparatively analyzed. Meanwhile,the distribution of funguses was observed by fungal cultures and identification. Results There were significantly differences in the time of using antibacterial drugs,the levels of serum albumin,the numbers which used glucocorticoid more than 2 weeks,complication with diabetes,respiratory failure,and using mechanical ventilation between the observation group and the control group（ P〈0. 01）.Multifactor regression analysis indicated that long-term use of antibiotics,glucocorticoid,hypoalbuminemia,diabetes and respiratory failure,mechanical ventilation were the risk factors of pulmonary fungal infections in elderly patients with COPD（ P〈0. 05）. In fungal infections,the main strain is Candida,among which Candida albicans accounted for the highest detection rate. Conclusion Antibiotics and glucocorticoid should be rationally used for the treatment of COPD and avoiding excessive use of invasive mechanical ventilation and paying more attention to the treatment of complications are also helpful for pulmonary fungal infections.

关 键 词：慢性阻塞性肺疾病 肺部真菌感染 临床诊断 

分 类 号：R563[医药卫生—呼吸系统]