机构地区:[1]湖州市中心医院湖州师范学院附属中心医院RICU,浙江湖州313000
出 处:《中华医院感染学杂志》2022年第13期1960-1964,共5页Chinese Journal of Nosocomiology
基 金:浙江省科技计划基金资助项目(2017C37155)。
摘 要:目的分析慢性阻塞性肺病(COPD)合并肺部真菌感染(PFIH)外周血(1-3)-β-D葡聚糖和淋巴细胞CD_(3)^(+)CD_(4)^(+)、CD_(3)^(+)CD_(8)^(+)水平变化。方法选取2019年5月-2021年5月在湖州市中心医院就诊的56例COPD合并PFIH患者为感染组,另随机选取同期医院就诊的56例COPD未合并PFIH患者为未感染组。分析感染组痰液培养菌种分布,比较两组临床资料,采用Logistic回归分析影响COPD合并PFIH的危险因素,采用受试者工作特征(ROC)曲线分析COPD患者外周血(1-3)-β-D葡聚糖和淋巴细胞CD_(3)^(+)CD_(4)^(+)、CD_(3)^(+)CD_(8)^(+)水平与PFIH的关系。结果56例COPD合并PFIH患者共分离出83株病原菌,以白假丝酵母(43.37%)为主。Logistic回归分析显示,有糖尿病史、合并低蛋白血症、有机械通气均为影响COPD并发PFIH的危险因素(P<0.05)。感染组患者(1,3)-β-D葡聚糖、CD_(3)^(+)CD_(8)^(+)水平高于未感染组,CD_(3)^(+)CD_(4)^(+)、CD_(3)^(+)CD_(4)^(+)/CD_(3)^(+)CD_(8)^(+)水平低于未感染组,差异均有统计学意义(P<0.05)。ROC曲线结果显示,外周血(1,3)-β-D葡聚糖和淋巴细胞CD_(3)^(+)CD_(4)^(+)、CD_(3)^(+)CD_(8)^(+)水平诊断COPD并发PFIH的曲线下面积分别为0.885、0.866、0.876。结论外周血(1,3)-β-D葡聚糖、淋巴细胞CD_(3)^(+)CD_(4)^(+)、CD_(3)^(+)CD_(8)^(+)可作为早期诊断COPD患者发生PFIH感染的重要指标。OBJECTIVE To observe the changes of(1-3)-β-D glucan and lymphocytes CD_(3)^(+)CD_(4)^(+) and CD_(3)^(+)CD_(8)^(+) in peripheral blood of chronic obstructive pulmonary disease(COPD)patients complicated with pulmonary fungal infection(PFIH).METHODS A total of 56 COPD patients complicated with PFIH who were treated in Huzhou Central Hospital from May 2019 to May 2021 were assigned as the infection group,meanwhile,56 COPD patients without PFIH were chosen as the no infection group.The distribution of species of pathogens isolated from sputum specimens was observed,the clinical data were compared between the two groups,logistic regression analysis was performed for risk factors for PFIH in the COPD patients,and the relationship between the peripheral blood(1-3)-β-D glucan and lymphocytes CD_(3)^(+)CD_(4)^(+) and CD_(3)^(+)CD_(8)^(+) and the PFIH was analyzed by means of receiver operating characteristic(ROC)curve.RESULTS Totally 83 strains of pathogens were isolated from the 56 COPD patients complicated with PFIH,43.37%of which were Candida albicans.Logistic regression analysis showed that the history of diabetes mellitus,complication with hypoproteinemia and mechanical ventilation were the risk factors for PFIH in the COPD patients(P<0.05).The levels of(1,3)-β-D glucan and CD_(3)^(+)CD_(8)^(+) of the infection group were significantly higher than those of the no infection group,the levels of CD_(3)^(+)CD_(4)^(+) and CD_(3)^(+)CD_(4)^(+)/CD_(3)^(+)CD_(8)^(+) of the infection group were significantly lower than those of the no infection group(P<0.05).The result of ROC curve analysis showed that the areas under curves(AUCs)of peripheral blood(1,3)-β-D glucan,lymphocytes CD_(3)^(+)CD_(4)^(+) and CD_(3)^(+)CD_(8)^(+) were respectively 0.885,0.866 and 0.876 in diagnosis of PFIH in the COPD patients.CONCLUSION The peripheral blood(1,3)-β-D glucan,lymphocytes CD_(3)^(+)CD_(4)^(+) and CD_(3)^(+)CD_(8)^(+) can serve as important indexes for early diagnosis of PFIH in the COPD patients.
关 键 词:慢性阻塞性肺病 肺部真菌感染 (1-3)-β-D葡聚糖 淋巴细胞CD_(3)^(+)CD_(4)^(+) 淋巴细胞CD_(3)^(+)CD_(8)^(+)
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