ANCA相关性小血管炎合并感染的致病菌谱及预后分析  

Analysis of Microbiological Trends and Prognosis in Patients Suffered Infection with Antineutrophil Cytoplasmic Antibody (ANCA)-associated Vasculitis (AAV)

作　　者：常洁[1] 梁素忍[1] 郭佳音[1] 董少卿[1] 郭志玲[1] Chang Jie;Liang Suren;Guo jiayin(Department of Nephrology,the First Affiliated Hospital of Henan University of Science and Technology,Henan 471003,China)

机构地区：[1]河南科技大学第一附属医院肾内科

出　　处：《医学研究杂志》2019年第5期134-139,共6页Journal of Medical Research

基　　金：河南科技大学基金资助项目(2009c20005)

摘　　要：目的分析抗中性粒细胞胞质抗体(ANCA)相关性小血管炎(AAV)合并感染患者的致病菌谱及药物敏感情况,探讨临床特点及预后影响因素,为临床合理防治提供科学依据和指导。方法选取1997年1月~2016年12月在笔者医院确诊的AAV合并感染的患者,收集临床资料,统计分析感染致病菌谱及药物敏感情况,并进一步分析影响预后的危险因素。结果本研究共纳入113例AAV合并感染患者,以肺部感染占绝大多数。体液致病菌培养98例次,培养阳性的55例次,培养阳性率为56.12%。G^+菌以葡萄球菌、链球菌和肠球菌为主,对万古霉素、利奈唑胺、替考拉宁的敏感度最高,G^-菌以克雷伯杆菌和肠杆菌为主,对美罗培南、亚胺培南及阿米卡星的敏感度较高。113例患者中12例最终死亡,均死于重症肺炎,合并真菌感染居多。病情好转组和死亡组患者在年龄、血红蛋白水平、外周血CD4^+T淋巴细胞计数及感染前3个月激素累计剂量方面比较,差异有统计学意义(P<0.05)。Logistic回归结果提示贫血和外周血CD4^+T淋巴细胞计数低下是AAV合并感染患者预后不良的独立危险因素。结论AAV患者常合并肺部感染,感染的微生物以细菌(葡萄球菌属和杆菌属)多见,需根据药物敏感选择敏感抗生素。机会性感染如真菌和卡氏肺孢子虫感染预后差。贫血及免疫功能低下是预后不良的独立危险因素。Objective To investigate the clinical characteristics and analysis of microbiological trends and prognosis in patients suffered infection with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods All the AAV patients with infection in our hospital from Janurary 1997 to December 2016 were enrolled in this study.The clinical information data were collected.The organisms and antimicrobial susceptibilities of patients with infection were analyzed.Further,we statistically analyzed the risk factors of prognosis of the infectious patients.Results 113 AAV patients with infection were enrolled in our study.The majority of the lung infection accounted for 75.38%.There were 98 cases of pathogenic bacteria cultivation,of which 55 cases were positive,and the positive rate was 56.12%.G^+ bacteria were mainly Staphylococcus,Streptococcus and Enterococcus,with the highest susceptibility to vancomycin,linezolid and teicoplanin.G^- bacteria were mainly Klebsiella and Enterobacteriaceae.The sensitivity to meropenem,imipenem and amikacin,were higher.12 patients died from severe pneumonia,and most of them had fungal infection.The patients were divided into improved group and poor prognosis group.Age,hemoglobin level,peripheral blood CD4^+T lymphocyte count and the cumulative dose of hormone in 3 months before infection between the two groups were statistically significant ( P<0.05 ).The logistic regression results showed that anemia and lower peripheral blood CD4^+T lymphocyte count were independent risk factors for poor prognosis.Conclusion The AAV patients often complicated with pulmonary infection.The infection of bacteria (Staphylococcus and Bacillus) were more common,and sensitive antibiotics should be selected according to drug sensitivity.Opportunistic infections such as fungi and PCP infection had poor prognosis.Anemia and lower peripheral blood CD4……+T lymphocyte count were independent risk factors for poor prognosis.

关 键 词：抗中性粒细胞胞浆抗体血管炎 感染 致病菌 药敏试验 预后 

分 类 号：R59[医药卫生—内科学]