慢阻肺患者继发肺部真菌感染的危险因素及其痰培养结果分析  

Risk factors and sputum culture results of pulmonary fungal infection in patients with chronic obstructive pulmonary disease

作　　者：王瑞玲[1] 张继跃[1] 刘慧君[1] WANG Rui-ling;ZHANG Ji-yao;LIU Hui-jun(Affiliated Hospital of Jining Medical College,Jining 300450,Shandong,China)

机构地区：[1]济宁医学院附属医院,山东济宁272029

出　　处：《中国病原生物学杂志》2018年第7期781-784,788,共5页Journal of Pathogen Biology

摘　　要：目的分析慢性阻塞性肺疾病(COPD)患者继发肺部真菌感染的危险因素及其痰培养结果。方法回顾性分析41例COPD继发肺部真菌感染的患者(研究组)和60例未发生肺部真菌感染的COPD患者(对照组)的临床资料,比较研究组的病原菌构成及耐药情况;通过多因素Logistic回归分析COPD患者继发肺部真菌感染的危险因素。结果研究组检出324株真菌,以白色念珠菌较常见(占63.58%)。分离菌对两性霉素B的耐药率较低(1.46%),而白色念珠菌对氟康唑等其它4种抗真菌药物的耐药性为1.46%~3.88%。研究组患者的年龄,合并肺源性心脏病、糖尿病、呼吸衰竭及机械通气的比例,抗菌药物和激素使用时间、ICU住院时间及血清白蛋白水平与对照组比较差异均有统计学意义(P<0.05);多因素Logistic回归分析显示:高龄,合并肺源性心脏病、糖尿病、呼吸衰竭,机械通气,长期使用抗菌药物和激素及ICU住院时间长均是COPD患者继发肺部真菌感染的危险因素(P<0.05),而血清白蛋白增高是COPD患者继发肺部真菌感染的保护性因素(P<0.05)。结论 COPD患者继发肺部感染的真菌以白色念珠菌多见,两性霉素B治疗COPD继发肺部真菌感染的耐药率低。COPD患者发生继发肺部真菌感染的危险因素涉及高龄,合并肺源性心脏病、糖尿病、呼吸衰竭等多个方面。临床上应重视对上述危险因素的干预,提高真菌性肺炎的防治效果。Objective To analyze the risk factors and sputum culture results of pulmonary fungal infection in patients with chronic obstructive pulmonary disease（COPD）. Methods The clinical data of 41 cases of COPD with pulmonary fungal infection（study group）and 60 cases of COPD without pulmonary fungal infection（control group）were analyzed retrospectively.The pathogenic microorganism composition and drug resistance of the study group were analyzed.The risk factors of pulmonary fungal infection in COPD patients were analyzed by multiple factor Logistic regression. Results 324 strains of fungi were detected in the study group,the most common fungi was Candida albicans（63.58%）.The resistance rate of isolated strains to Amphotericin B was relatively low（1.46%）.The resistance of C.albicans to 4 other antifungal agents,such as fluconazole,was 1.46%to 3.88%.The difference of age,the proportion of pulmonary heart disease,the proportion of diabetes,the proportion of respiratory failure,the proportion of mechanical ventilation,the time of using antibiotics,the time of using hormone,the time of ICU hospitalization and the serum albumin level between the study group and the control group were statistically significant.Multifactor Logistic regression analysis showed that age,pulmonary heart disease,diabetes,respiratory failure,mechanical ventilation,long term use of antibiotics and hormone,long ICU hospitalization time were the risk factors for secondary pulmonary fungal infection in COPD patients（P〈0.05）,and high level of serum albumin was the protective factor for secondary pulmonary fungal infection in COPD patients（P〈0.05）. Conclusion C.albicans is the most common pathogen of secondary pulmonary fungal infection in COPD patients.The resistance rate of Amphotericin B to COPD secondary pulmonary fungal infection is low.The risk factors for secondary pulmonary fungal infections in COPD patients involve age,pulmonary heart disease,diabetes mellitus,respiratory failure,and so on.We should attach importance

关 键 词：慢性阻塞性肺疾病 肺部真菌感染 危险因素 痰培养 

分 类 号：R379[医药卫生—病原生物学]