慢性阻塞性肺疾病合并侵袭性肺曲霉病的临床特征及危险因素分析  

Clinical features and risk factors of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

作　　者：张蕾[1,2] 杨青[1] 赵钊[2] 俞炯[1] 曹红翠[1] Zhang Lei;Yang Qing;Zhao Zhao;Yu Jiong;Cao Hongcui(State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Infectious Diseases,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,Hangzhou 310003,China;Clinical Laboratory,Zhejiang Provincial People’s Hospital,Hangzhou 310014,China)

机构地区：[1]浙江大学医学院附属第一医院传染病诊治国家重点实验室,国家感染性疾病临床医学研究中心,感染性疾病诊治协同创新中心,杭州310003 [2]浙江省人民医院检验科,杭州310014

出　　处：《中华临床感染病杂志》2020年第2期113-118,共6页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉病(IPA)患者的临床特点、胸部CT影像学特征及其危险因素,为临床早期诊断和预防提供依据。方法收集浙江大学医学院附属第一医院和浙江省人民医院2015年1月至2019年9月COPD合并IPA的90例患者作为病例组,并按1∶2配对原则,选取同年入院、性别一致、年龄±5岁的COPD未合并IPA的180例患者为对照组,对病例组和对照组患者的一般情况和临床资料进行回顾性分析,采用χ2检验比较两组患者的肺部影像学特征,采用多因素条件Logistic回归分析探讨COPD合并IPA的危险因素。结果COPD合并IPA的90例患者中,下呼吸道标本培养出烟曲霉78例、黄曲霉6例、烟曲霉合并黄曲霉1例、土曲霉1例、黑曲霉1例;1例痰脱落细胞学找到曲霉菌丝,2例血清半乳甘露聚糖试验阳性。病例组患者胸部CT影像学表现为片状浸润影(87.8%)、胸腔积液(36.7%)、结节(33.3%)、空洞(18.9%)、实变影(17.8%)、晕轮征(14.4%)和空气新月征(2.2%),且片状浸润影、实变影、晕轮征以及空洞的发生率较对照组高(P<0.05或<0.01)。多因素条件Logistic回归分析显示,住院时间长(OR=1.183,95%CI 1.047~1.336)、两种抗菌药物联用(OR=5.391,95%CI 1.241~23.421)、抗菌药物使用时间≥14 d(OR=5.275,95%CI 1.586~17.541)、抗菌药物累计使用品种数多(OR=2.270,95%CI 1.406~3.664)是COPD合并IPA的危险因素(P<0.05或<0.01)。结论若COPD患者存在住院时间较长、两种抗菌药物联合使用、抗菌药物治疗≥14 d、抗菌药物使用种类较多这些危险因素,应进行病原学、血清学检查和胸部CT动态监测,以便于临床早期诊断和预防IPA的发生。Objective To analyze the clinical features and risk factors of invasive pulmonary aspergillosis(IPA)in patients with chronic obstructive pulmonary disease(COPD).Methods Ninety COPD patients with IPA admitted in the First Affiliated Hospital,Zhejiang University School of Medicine and Zhejiang Provincial People’s Hospital from January 2015 to September 2019 were enrolled,and 180 COPD patients without IPA admitted in the same period were selected as control group.The clinical data of the patients in both groups were analyzed retrospectively.Chi square test was used to compare the imaging characteristics of patients in two groups,and multivariate conditional Logistic regression analysis was used to explore the risk factors of IPA in COPD patients.Results Among 90 cases of COPD with IPA,the culture of lower respiratory tract samples identified Aspergillus fumigatus in 78 cases,Aspergillus flavus in 6 cases,Aspergillus fumigatus with Aspergillus flavus in 1 case,Aspergillu sterrus in 1 case,and Aspergillus nigerwere in 1 case;1 case of Aspergillus mycelium was found by sputum exfoliation cytology and 2 cases were positive for serum galactomannan.Chest CT images showed patchy infiltrating shadow(87.8%),pleural effusion(36.7%),nodules(33.3%),cavity(18.9%),consolidation shadow(17.8%),halo sign(14.4%)and air crescent sign(2.2%).The incidence of patchy infiltrating shadow,consolidation shadow,halo sign and cavity were higher in COPD patients with IPA compared to control group(P<0.05 or P<0.01).Multivariate conditional Logistic regression analysis showed that prolonged hospital stay(OR=1.183,95%CI 1.047-1.336),combination of two antibiotics(OR=5.391,95%CI 1.241-23.421),duration of antibiotic treatment≥14 days(OR=5.275,95%CI 1.586-17.541),cumulative use of antibiotics(OR=2.270,95%CI 1.406-3.664)were the risk factors of COPD with IPA(P<0.05 or P<0.01).Conclusion The risk factors of IPA in COPD patients include long duration of hospital stay,combination of two kinds of antibiotics,more than 14 days of antibiotic treatment,a

关 键 词：肺疾病 慢性阻塞性 侵袭性肺曲霉病 临床特征 危险因素 

分 类 号：R563.9[医药卫生—呼吸系统] R519[医药卫生—内科学]