重症狼疮肾炎血液滤过治疗患者合并肺部真菌感染的真菌分布及危险因素分析  

Distribution and risk factors of pulmonary fungal infection in patients with severe lupus nephritis treated with continuous veno venous hemofiltration

作　　者：蒋红梅[1] 杨萌[1] 刘岚[1] Jiang Hongmei;Yang Meng;Liu Lan(Blood Purification Center,Suining Central Hospital,Suining 629000,Sichuan,China)

机构地区：[1]四川省遂宁市中心医院血液净化中心,遂宁629000

出　　处：《国际流行病学传染病学杂志》2022年第4期268-272,共5页International Journal of Epidemiology and Infectious Disease

摘　　要：目的了解重症狼疮肾炎连续性静脉-静脉血液滤过治疗患者合并肺部真菌感染的真菌分布及其危险因素。方法选择2018年1月至2021年1月遂宁市中心医院接受连续性静脉-静脉血液滤过治疗的重症狼疮肾炎患者120例作为研究对象,收集患者的性别、年龄、体重指数和疾病活动指数等资料。根据治疗期间发生肺部真菌感染情况分为感染组(58例)和未感染组(62例)。分析感染组患者的真菌分布情况以及药敏结果,采用多因素Logistic回归分析研究肺部真菌感染的危险因素。结果肺部真菌感染组患者以白假丝酵母菌感染为主(36例,62.07%),对于氟康唑、灰黄霉素以及咪康唑的耐药率分别为62.07%、56.90%、51.72%。感染组28 d死亡率(17.24%)高于未感染组(χ2=6.54,P=0.011)。多因素分析显示,疾病活动指数>19(OR=2.779,95%CI:1.135~3.936)、日均使用糖皮质激素剂量>50 mg(OR=2.898,95%CI:1.336~4.520)、联合使用免疫抑制剂(OR=1.452,95%CI:1.030~2.073)、连续使用抗菌药物2周以上(OR=1.992,95%CI:1.138~2.891)以及使用2种以上的抗菌药物(OR=1.571,95%CI:1.016~2.317)均是造成患者肺部真菌感染的危险因素。结论重症狼疮肾炎连续性静脉-静脉血液滤过治疗患者合并肺部真菌感染主要以白假丝酵母感染为主,对氟康唑等药物耐药率较高,死亡率也较高。疾病活动指数、日均使用糖皮质激素剂量过高、联合使用免疫抑制剂、连续使用抗菌药物2周以上以及使用2种以上的抗菌药物是造成患者肺部真菌感染的危险因素。Objective To understand the distribution and risk factors of pulmonary fungal infection in patients with severe lupus nephritis treated with continuous veno venous hemofiltration.Methods A total of 120 patients with severe lupus nephritis treated with continuous veno venous hemofiltration in Suining Central Hospitalfrom January 2018 to January 2021 were selected as the research objects.The data of gender,age,body mass index,disease activity index,and other information were collected.The patients were divided into infection group(58 cases)and non-infection group(62 cases)according to the occurrence of pulmonary fungal infection during treatment.The distribution and drug sensitivity of fungi in the infection group were analyzed,and multivariate Logistic regression analysis was used to study the risk factors of pulmonary fungal infection.Results The patients with pulmonary fungal infection were mainly infected by Candida albicans(36 cases,62.07%),and the resistance rates to fluconazole,griseofulvin and miconazole were 62.07%,56.90%,and 51.72%,respectively.The 28-day mortality rate in the infection group was 17.24%,which was significantly higher than that in the non-infection group(χ2=6.54,P=0.011).Multivariate Logistic regression analysis showed that disease activity index>19(OR=2.779,95%CI:1.135-3.936),daily dose of glucocorticoids>50 mg(OR=2.898,95%CI:1.336-4.520),combined use of immunosuppressants(OR=1.452,95%CI:1.030-2.073),continuous use of antibiotics for more than two weeks(OR=1.992,95%CI:1.138-2.891)and the use of more than two kinds of antibiotics(OR=1.571,95%CI:1.016-2.317)were the risk factors of pulmonary fungal infection.Conclusions Patients with severe lupus nephritis treated with continuous veno venous hemofiltration are mainly co-infected with Candida albicans,which has high resistant rate to fluconazole and has high mortality rate.Disease activity index,high daily dose of glucocorticoid,combined use of immunosuppressants,continuous use of antibiotics for more than two weeks and use of more than two

关 键 词：狼疮肾炎 静脉-静脉血液滤过 疾病活动指数 危险因素 真菌感染 合并感染 耐药 

分 类 号：R593.242[医药卫生—内科学] R519[医药卫生—临床医学]