念珠菌血症患者的临床及预后危险因素分析  

Clinical characteristics and prognostic risk factors of candidemia

作　　者：苏冬梅[1] 张波[1] 黄燕[1] 刘一[1] 刘颖[1] 任明霞[1] 廖理菊[1] 

机构地区：[1]中国人民解放军空军总医院呼吸内科,北京100142

出　　处：《临床肺科杂志》2017年第5期914-918,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的研究念珠菌血症的临床特征并探究影响其预后的危险因素。方法回顾分析空军总医院2013年1月至2016年6月血培养念珠菌阳性病例,收集患者相应的临床及微生物资料,分组比较白色念珠菌与非白色念珠菌组及死亡组与存活组的临床特征,并探究影响其预后的危险因素。结果共纳入42例,白色念珠菌血症9例,非白色念珠菌血症33例,平均年龄(53.5±26.9岁),总住院死亡率为54.8%(23/42)。死亡组男性、APACHEⅡ评分、念珠菌评分、合并气管插管或切开、肝功能损害、脓毒症及休克、多脏器功能衰竭均大于存活组(P<0.05)。多因素Logistic回归分析显示:APACHEⅡ评分[OR=1.250,P=0.047]、脓毒症及休克[OR=6.643,P=0.036]是患者死亡的独立危险因素。年龄>60岁是白色念珠菌血症的独立危险因素,热带念珠菌血症多见于年龄≤60岁患者(P<0.05)。ROC曲线表明念珠菌评分≥2.5、APACHEⅡ评分≥16.5是预测患者住院期间死亡的最佳切点,曲线下面积(AUC)分别为0.760、0.770,预测的准确度为中等。结论念珠菌血症以非白色念珠菌为主,病情重,病死率高,除APACHEⅡ评分外,念珠菌评分也可作为患者预后不良的指标。Objective To explore the clinical characteristics and prognostic risk factors of candidemia. Methods The clinical features, microbiological data with eandidemia in the Air Force Hospital of PLA were ana- lyzed retrospectively. Comparisons were made with regards to the clinical features and prognostic risk factors between the dead and survival groups. Results A total of 42 cases selected, including 9 cases of C. albieans and 33 non - C. albicans cases. Their mean age was （53.5 ±26. 9） years, and the total in-hospital fatality was 54. 8% （23/42）.The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ score）, male, candida score, tracheal intubation or incision, liver disfunction, sepsis and septic shock, and MOF were higher in the death group than in the survival group. Multivariate logistic regression analysis showed that APACHE lI score （ OR = 1. 250, P = 0. 047 ）, and sepsis and septic shock （OR =6. 643, P =0. 036） were independent risk factors for death. Patients with age over 65 years old was independent risk factor for C. albieans. C. tropicals occurred more frequently in patients aged less than 60 years （P〈0. 05）. ROC curves showed that candida score more than 2. 5, and APACHEⅡ score more than 16.5 were the optimal cut-off points to predict the mortality, and area under the curve （AUC） were 0. 760 and 0. 770 re- spectively. The accuracy were medium. Conclusion The type of non-albicans species is mainly pathogen of candi- demia, and the patients have severe clinical conditions and high mortality. In addition to APACHE Ⅱ score, candida score can also be used as an surrogate marker of poor prognosis in patients with candidemia.

关 键 词：念珠菌病 真菌血症 临床分析 念珠菌评分 预后 

分 类 号：R519.3[医药卫生—内科学]