老年糖尿病并发肺部感染病原学及影响因素  

Etiology and influencing factors of pulmonary infection in the elderly with diabetes mellitus

作　　者：黄鸿[1] 黄芪[1] 徐海[1] 幸奠霞[1] 胡彬[1] 魏星[2] HUANG Hong;HUANG Qi;XU Hai;XING Dian-xia;HU Bin;WEI Xing(Chongqing Three Gorges Central Hospital,Chongqing404000,China)

机构地区：[1]重庆三峡中心医院老年科,重庆404000 [2]重庆三峡中心医院骨科脊柱病区,重庆404000

出　　处：《中华医院感染学杂志》2021年第8期1179-1182,共4页Chinese Journal of Nosocomiology

基　　金：重庆市自然科学基金资助项目(2019382)。

摘　　要：目的探究老年糖尿病患者合并肺部感染的病原学特征及其影响因素。方法收集2018年6月-2019年12月重庆三峡中心医院老年科接诊的105例2型糖尿病合并肺部感染的老年患者为感染组,收集合并肺部感染患者痰液进行病原菌培养,进行病原学分析;另选择同期年龄、性别比例相匹配的50例无肺部感染的2型糖尿病患者作未感染组,分析其合并肺部感染的影响因素;根据肺炎严重指数(PSI),将感染组患者分为低危组、中危组及高危组,比较各组患者血液相关指标水平:白蛋白(ALB)、25羟维生素D[25(OH)D]、红细胞比容(HCT)、降钙素原(PCT)、C反应蛋白(CRP)。结果合并肺部感染患者病原菌以革兰阴性菌为主,占比61.36%;病程、住院时间、ALB、25(OH)D、HCT、既往肺部疾病史及糖尿病相关并发症均是2型糖尿病并发肺部感染的独立影响因素(P<0.05);不同感染程度患者血清ALB、25(OH)D、HCT、PCT及CRP水平比较,差异有统计学意义(P<0.05),且随着感染程度的加剧,患者HCT、PCT及CRP水平升高,ALB和25(OH)D水平降低(P<0.05)。结论2型糖尿病并发肺部感染患者病原菌以革兰阴性菌为主,其影响因素较多,临床应采取相应针对性措施,便于糖尿病患者肺部感染的防控。OBJECTIVE To explore the etiological features of pulmonary infection in elderly patients with diabetes mellitus,and analyze its influencing factors.METHODS A total of 105 elderly patients with type 2 diabetes mellitus(T2 DM)and pulmonary infection treated in geriatrics department of Chongqing Three Gorges Central Hospital from Jun 2018 to Dec 2019 were enrolled in the infection group.The sputum from patients with pulmonary infection was collected for pathogenic culture and etiological analysis.Another 50 T2 DM patients with matched age and gender ratio during the same period and without pulmonary infection were enrolled in the non-infection group.The risk factors for pulmonary infection were analyzed.According to pneumonia severity index(PSI),patients in the infection group were divided into the low-risk,moderate-risk and high-risk groups.The levels of blood-related indexes,including albumin(ALB),25-hydroxyvitamin D[25(OH)D],hematocrit(HCT),procalcitonin(PCT)and C-reactive protein(CRP)were compared among all groups.RESULTS Gram-negative bacteria were the main pathogens in patients with pulmonary infection,accounting for 61.36%.The course of disease,hospitalization time,ALB,25(OH)D,HCT,previous pulmonary disease history and diabetes-related complications were all independent risk factors for T2 DM complicated by pulmonary infection(P<0.05).There were significant differences of levels of serum ALB,25(OH)D,HCT,PCT and CRP among patients with different infection degrees(P<0.05).With the aggravation of infection,levels of HCT,PCT and CRP were increased,while levels of serum ALB and 25(OH)D were decreased(P<0.05).CONCLUSION Gram-negative bacteria are the main pathogenic bacteria in patients with T2 DM complicated by pulmonary infection,which may be related to many risk factors.Clinically,corresponding and targeted measures should be conducted to prevent pulmonary infection in diabetes mellitus patients.

关 键 词：老年糖尿病 肺部感染 病原学 影响因素 

分 类 号：R563.1[医药卫生—呼吸系统]