AECOPD患者下呼吸道标本念珠菌阳性危险因素分析  

Risk factors of positive isolation of Candida species in lower respiratory tract specimens from patients with AECOPD

作　　者：王玮琴 张静[2] 金晓燕[3] 左依慧 瞿介明[1] Wang Weiqin;Zhang Jing;Jin Xiaoyan;Zuo Yihui;Qu Jieming(Department of Pulmonary and Critical Care Medicine,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Pulmonary and Critical Care Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Pulmonary and Critical Care Medicine,Tongren Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200335,China)

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸与危重症医学科,200025 [2]复旦大学附属中山医院呼吸与危重症医学科,上海200032 [3]上海交通大学医学院附属同仁医院呼吸与危重症医学科,200335

出　　处：《国际呼吸杂志》2021年第1期24-31,共8页International Journal of Respiration

摘　　要：目的探讨慢性阻塞性肺疾病急性加重(AECOPD)患者下呼吸道标本念珠菌阳性的危险因素。方法选取上海市26家医院2011年1月至2016年12月因COPD急性加重住院的患者作为研究对象进行回顾性研究,将下呼吸道标本念珠菌阳性的502例患者设定为试验组,将下呼吸道标本真菌阴性的304例患者设定为对照组,对念珠菌阳性患者的相关情况进行分析,同时采用单因素分析以及多因素Logistic回归进行分析。结果(1)念珠菌构成比以白色念珠菌居第一位,所占比例为85.48%;光滑念珠菌第二位,所占比例为7.66%;其次为热带念珠菌和酵母样菌,所占比例分别为2.82%和2.62%;最后为近平滑念珠菌和克柔念珠菌,所占比例分别为1.01%和0.40%。(2)试验组和对照组患者相关危险因素分析后发现,试验组患者年龄、入院时间、慢性阻塞性肺疾病评估测试评分、呼吸困难量表评分、吸烟量、第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积/FVC、合并哮喘和阻塞性睡眠呼吸暂停综合征、合并脑卒中、按需吸入短效β2受体激动剂(SABA)、吸入长效β2受体激动剂(LABA)、吸入糖皮质激素(ICS)、ICS/LABA、静脉使用糖皮质激素、抗生素使用天数、住院时间、住重症监护病房(ICU)时间、白细胞计数、中性粒细胞、C-反应蛋白、降钙素原、氢离子浓度指数、动脉血二氧化碳分压和动脉血氧分压之间差异均有统计学意义(P值均<0.05)。(3)Logistic多因素回归分析后发现,年龄>70岁、入院次数>4次、按需吸入SABA、吸入LABA、ICS、ICS/LABA、住院时间>30 d以及住ICU时间>25 d为AECOPD患者下呼吸道标本念珠菌阳性的危险因素。结论AECOPD患者下呼吸道标本念珠菌阳性危险因素主要为年龄>70岁、入院次数>4次、按需吸入SABA、吸入LABA、ICS、ICS/LABA、住院时间>30 d以及住ICU时间>25 d,下呼吸道念珠菌定植的临床意义有待进一步研�Objective To determine the risk factors of positive isolation of Candida species in lower respiratory tract specimens of patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods From January 2011 to December 2016,all the patients diagnosed with AECOPD in 26 hospitals in Shanghai were included into analysis.A total of 502 patients suffering from positive isolation of Candida species were allocated into the experimental group,and 304 patients with negative results were divided into the control group.Univariate analysis and multivariate logistic regression were used to identify the risk factors of positive isolation of Candida species in patients with COPD.Results Among the different Candida species,Candida albicans was most commonly isolated with the percentage of 85.48%,followed by Candida glabrata accounting for 7.66%,Candida tropicalis accounting for 2.82%,Saccharomycopsis,accounting for 2.62%,respectively.Candida parapsilosis and Candida krusei were the least isolated,accounting for 1.01%and 0.40%.(2)Univariate analysis showed that the following variables were significantly different between the two groups,including age,admission date,COPD assessment test score,modified Medical Research Council score,smoking volume,forced expiratory volume in the first second as a percentage of expected value,forced expiratory volume in the first second/forced vital capatity,asthma,obstructive sleep apnea syndrome,stroke,inhaled short actingβ2 receptor agonist(SABA),inhaled long actingβ2 receptor agonist(LABA),inhaled corticosteroids(ICS),ICS/LABA,intravenous corticosteroids,days of antibiotic use,hospital stay and ICU stay(P<0.05).In addition,counts of white blood cells and neutrophils,C-reactive protein,procalcitonin,pH,partial pressure of carbon dioxide in artery and alveolar oxygen partial pressure were also statistically distinct between two groups(all P<0.05).(3)Binary logistic regression analysis demonstrated the senile(age>70 years),repeated admission(>4 times),inhalation o

关 键 词：肺疾病 慢性阻塞性 危险因素 急性加重 念珠菌阳性 

分 类 号：R563.9[医药卫生—呼吸系统]