激素及免疫抑制剂治疗相关性肺炎患者病原学阴性和阳性的临床特征和死亡率的比较  

Comparison of clinical characteristics and mortality between positive and negative etiology in patients with pneumonia receiving chronic glucocorticoids

作　　者：武元星[1] 黄艳[1] 朱光发[1] WU Yuan;HUANG Yan;ZHU Guangfa(Department of Respiratory and Critical Care Medcine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Disease,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所呼吸内科,100029

出　　处：《心肺血管病杂志》2022年第3期257-262,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨应用糖皮质激素和或免疫抑制剂治疗合并肺炎的病原学阴性和阳性患者的临床特征和预后。方法:本研究是一项在中国开展的多中心回顾性队列研究的事后分析,根据病原学检查结果,将所有患者分为病原学阴性组和病原学阳性组。结果:病原学阳性患者有508例,病原学阴性患者有208例,病原学阳性组发热(77.0%vs.68.8%)、咳嗽(90.0%vs.82.2%)、呼吸困难(67.5%vs.42.3%)及咳痰(83.8%vs.74.5%)的比例显著高于阴性组(所有P<0.05),病原学阳性组有创通气(28.7%vs.12.5%)、无创通气(27.6%vs.15.9%)、气管插管(29.8%vs.12.3%)、ICU治疗(47.6%vs.24.0%)、CURB65>1(31.7%vs.20.4%)、30d死亡(25.2%vs.16.3%)和90d死亡(29.5%vs.17.3%)的比例均显著高于病原学阴性组(所有P<0.05),且病原学阳性与90d死亡风险增加相关(HR=1.534,95%CI:1.025~2.295,P=0.038)。结论:在长期应用糖皮质激素治疗合并肺炎的患者中,病原学阳性的患者肺炎症状更重,30d和90d死亡率更高,且病原学阳性与90d死亡风险增加独立相关。Objective:To investigate the clinical characteristics and mortality between positive and negative etiology in patients with pneumonia receiving chronic glucocorticoids and/or immunosuppressants.Methods:This study was a post hoc analyses of a multi-center retrospective cohort study conducted in China.All patients were divided into a negative group and a positive group based on etiological examination results.Results:There were 508 patients with positive etiology and 208 patients with negative etiology.The proportion of fever(77.0%vs.68.8%),cough(90.0%vs.82.2%),dyspnea(67.5%vs.42.3%)and expectoration(83.8%vs.74.5%)in positive group was significantly higher than those in negative group(all P<0.05),invasive ventilation(28.7%vs.12.5%),non-invasive ventilation(27.6%vs.15.9%),endotracheal intubation(29.8%vs.12.3%),ICU admission(47.6%vs.24.0%),CURB65>1(31.7%vs.20.4%),30-day mortality(25.2%vs.16.3%),and 90-day mortality(29.5%vs.17.3%)were significantly higher than those in the negative etiology group(all P<0.05).Positive etiology was independently associated with an increased risk of 90-day mortality(HR=1.534,95%CI:1.025-2.295,P=0.038).Conclusions:In patients with pneumonia while receiving glucocorticoid therapy,etiology-positive patients had more severe pneumonia symptoms and higher 30-day and 90-day mortality.Positive etiology was independently associated with an increased risk of 90-day mortality.

关 键 词：病原学 肺炎 糖皮质激素 死亡 

分 类 号：R54[医药卫生—心血管疾病]