结核重症监护室真菌感染的危险因素分析  

Analysis on Risk Factors of Fungus Infection in Severe Pulmonary Tuberculosis ICU

作　　者：张楠[1] 李琦[2] 潘丽萍[3] 骆宝建[1] 刘秋月[1] Zhang Nan;LI Qi;Pan Liping;Luo Baojian;Liu Qiuyue(Department of Intensive Care Unit,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院ICU,101149 [2]首都医科大学附属北京胸科医院结核科 [3]首都医科大学附属北京胸科医院耐药结核病研究北京市重点实验室

出　　处：《结核病与胸部肿瘤》2019年第2期117-120,共4页Tuberculosis and Thoracic Tumor

基　　金：北京市科技新星计划(Z161100004916080);北京市医院管理局“青苗”计划专项(QML20181603).

摘　　要：目的探讨分析重症监护室(ICU)住院肺结核患者真菌感染的危险因素。方法收集2015年1月-2016年9月首都医科大学附属北京胸科医院ICU住院的116例肺结核患者的临床资料,进行回顾性分析,并按照是否合并真菌感染分为真菌组35例及非真菌组81例。采用Logistic回归分析真菌感染的影响因素。结果116例肺结核患者35例发生真菌感染,发生率为30.17%.单因素分析结果显示,合并糖尿病、肺部其他疾病、咯血、病变范围>3个肺野、空洞、纤维化、应用广谱抗生素>1周、糖皮质激素>1周、侵袭性操作及白蛋白水平等10个因素均与并发肺部真菌感染存在相关性(P<0.05或P<0.01)。多因素分析结果显示,应用糖皮质激素>1周、广谱抗生素使用>1周、进行侵袭性操作为真菌感染的独立危险因素,而白蛋白水平为真菌感染的保护性因素(P<0.05或P<0.01)。结论ICU住院肺结核患者真菌感染率高,对于长期应用糖皮质激素、进行侵袭性操作、应用广谱抗生素,低白蛋白水平的患者应警惕真菌感染风险,应及早预防及诊治。Objective To explore risk factors contributing to fungus infection in severe pulmonary tuberculosis ICU.Methods Clinical data of 116 patients from Beijing Chest Hospital,Capital Medical University from January 2015 to September 2016 were collected and analyzed retrospectively.The patients were divided into fungus infected group 35 cases and non fungus infected group 81 cases.The risk factors contributing to fungus infection were analyzed by Logistic analysis.Results There were 35 cases in the 116 cases were fungus infected and the incidence of fungal infection in tuberculosis patients in the ICU was 30.17%.Single factor analysis showed that 10 factors including complicated with diabetes,other diseases in the lung,hemoptysis,the lung lesion range > 3 pulmonary lobes,cavity,fibrosis,usage of antibiotics and glucocorticoid more than 1 week,traumatic operation and serum albumin level correlated with pulmonary fungal infection(P < 0.05 or P < 0.01).The Logistic regression analysis showed that independent predictive risk factors of fiingus infection were usage of glucocorticoid and antibiotics over 1 week,traumatic operation,and serum albumin level was the protect factor (P< 0.05 or P <0.01).Conclusion Patients with pulmonary tuberculosis in ICU has a higher rate of fungus infection.Patients with long-term glucocorticoids,invasive operations,and using broad-spectrum antibiotics and low albumin level should be aware of the risk of fungal infection,and should take early prevention,diagnosis and treatment.

关 键 词：肺结核 真菌感染 危险因素 监护室 

分 类 号：R519[医药卫生—内科学]