早期慢性肾衰竭患者并发肺部感染的临床特点、病原菌检出情况及相关危险因素分析  

Clinical characteristics of a pulmonary infection in patients with early chronic renal failure, detection of pathogens, and analysis of related risk factors

作　　者：叶寅寅[1] 赵洪静 张金玉[1] 金月[1] 汪裕伟[1] 杨沿浪[1] YE Yin-yin;ZHAO Hong-jing;ZHANG Jin-yu;JIN Yue;WANG Yu-wei;YANG Yan-lang(Nephrology,Yijishan Hospital of Wannan Medical College,Anhui,Wuhu 241001,China)

机构地区：[1]皖南医学院弋矶山医院肾脏内科,安徽芜湖241001

出　　处：《中国病原生物学杂志》2020年第10期1207-1209,1213,共4页Journal of Pathogen Biology

基　　金：皖南医学院校重点科研基金(No.WK2018ZF05)。

摘　　要：目的探讨早期慢性肾衰竭患者并发肺部感染的临床特点、病原菌检出情况及相关危险因素。方法选取2016年12月—2019年12月本院收治的208例早期慢性肾衰竭患者作为对象,分为感染组(发生肺部感染)以及非感染组(未发生肺部感染)。观察发生肺部感染患者的临床特点及痰液病原菌检出情况,并分析影响早期慢性肾衰竭患者并发肺部感染的危险因素。结果208例早期慢性肾衰竭患者中发生肺部感染58例,发生率为27.88%。其中,原发疾病以肾小球疾病居多(占65.52%,38/58),肺部感染诱因以急/慢性心衰为主(占50.00%,29/58,)。感染组血红蛋白(Hb)、白蛋白(Alb)、总蛋白(TP)水平显著低于非感染组(均P<0.05)。感染组58例痰液标本中共培养分离出26株病原菌,检出率为44.83%。其中,革兰阴性菌14株(占53.85%),革兰阳性菌4株(占15.38%),真菌8株(占30.77%)。多因素Logistic回归分析显示,年龄、糖尿病肾病、合并心衰、低蛋白血症、贫血均是早期肾衰患者发生肺部感染的危险因素(均P<0.05)。结论早期慢性肾衰竭患者并发肺部感染的病原菌以革兰阴性菌和真菌多见,临床应重视该类患者的痰培养结果,并根据病原菌检出情况合理应用抗生素治疗。肺部感染的发生与糖尿病肾病、合并心衰、低蛋白血症等多种因素有关,应给予高度关注,并采取积极有效的措施以预防感染的发生。Objectives To investigate the clinical characteristics of a pulmonary infection in patients with early chronic renal failure,to detect pathogens,and to analyze related risk factors.Methods Subjects were 208 patients with early chronic renal failure seen ato this Hospital from December 2016 to December 2019.Patients were divided into those with (a pulmonary infection)and those without a pulmonary infection.Deep sputum specimens were collected offrom patients with a pulmonary infection for pathogen culture and identification.The clinical characteristics of a pulmonary infection were examined,pathogens were detected in sputum,and the risk factors for a pulmonary infection were analyzed in patients with early chronic renal failure.Results Of 208 patients with early chronic renal failure,58 had a pulmonary infection,for a rate of infection of 27.88%.Glomerular disease was the most common primary disease(65.52%,38/58),and acute/chronic heart failure(50.00%,29/58)was the main cause of a pulmonary infection.In patients with a pulmonary infection,the hemoglobin(HB)level was 67.52±10.21 g/L,the albumin(ALB)level was 25.78±4.52 g/L,and the total protein(TP)level was 51.76±8.97 g/L.Levels were significantly lower than levels in patients without a pulmonary infection(P<0.05).In patients with a pulmonary infection,26 strains of pathogens were isolated from 58 sputum samples,for a rate of detection of 44.83%.The 26 strains included,14 strains of Gram-negative bacteria(53.85%),4 strains of Gram-positive bacteria(15.38%),and 8 strains of fungi(30.77%).Multivariate logistic regression analysis revealed that age,diabetic nephropathy,heart failure,hypoproteinemia,and anemia were all risk factors for a pulmonary infection in patients with early renal failure(P<0.05).Conclusion Gram-negative bacteria and fungi were the most common pathogens causing a pulmonary infection in patients with early chronic renal failure.Attention should be paid to sputum cultures from these patients,and antibiotics should be used rationally in accordance

关 键 词：慢性肾衰竭 肺部感染 病原菌 危险因素 

分 类 号：R378[医药卫生—病原生物学]