特发性炎性肌病间质性肺炎患者并发肺部感染病原菌及危险因素  

Pathogens and risk factors of pulmonary infection in patients with idiopathic inflammatory myopathy associated interstitial lung disease

作　　者：周小果[1] 党强[1] 李海剑[2] 门翔[1] 路尧 ZHOU Xiao-guo;DANG Qiang;LI Hai-jian;MEN Xiang;LU Yao(Nanyang Central Hospital,Nanyang,Henan 473005,China)

机构地区：[1]南阳市中心医院呼吸与危重症医学科,河南南阳473005 [2]南阳市中心医院风湿免疫科,河南南阳473005

出　　处：《中华医院感染学杂志》2024年第8期1150-1153,共4页Chinese Journal of Nosocomiology

基　　金：河南省科研基金资助项目(2021JH021310)。

摘　　要：目的探究特发性炎性肌病(IIM)间质性肺炎(IP)患者肺部感染的病原学特征及危险因素。方法将2019年12月-2023年4月南阳市中心医院收治的95例IIMIP患者发生与未发生肺部感染的临床资料分别纳入感染组(n=52)和非感染组(n=43)。统计IIMIP患者肺部感染的现况及病原学特征,通过单因素及多因素分析法分析IIMIP患者肺部感染的危险因素。结果95例IIMIP患者有52例发生肺部感染,肺部感染发生率为54.74%;共分离59株病原菌,其中革兰阴性菌、革兰阳性菌、真菌、巨细胞病毒和肺炎支原体占比分别为45.76%、28.81%、20.34%、3.39%、1.69%,革兰阴性菌以铜绿假单胞菌(11株)为主,革兰阳性菌以肺炎链球菌(7株)为主;多因素Logistic回归分析结果显示,外周血淋巴细胞计数、CD_(4)^(+)/CD_(8)^(+)及血清白蛋白、乳酸脱氢酶(LDH)是IIMIP患者肺部感染的危险因素(P<0.05)。结论IIMIP患者肺部感染的发生率高,且病原菌以革兰阴性菌为主;IIMIP患者肺部感染与外周血淋巴细胞计数、CD_(4)^(+)/CD_(8)^(+)、白蛋白、LDH关系密切;临床可据此予以早期针对性防治从而降低IIMIP患者肺部感染的发生风险。OBJECTIVE To explore the etiological characteristics and risk factors of pulmonary infection in patients with idiopathic inflammatory myopathy(IIM)associated interstitial pneumonia(IIP).METHODS The 95 IIM-IIP patients with and without pulmonary infection treated in Nanyang Central Hospital from Dec 2019 to Apr 2023 were assigned as the infected group(n=52)and non-infected group(n=43),respectively.The status and etio-logical characteristics of pulmonary infection in patients with IIM-IIP were analyzed.The risk factors of pulmonary infection in patients with IIM-IIP were analyzed by univairate and multivariate analysis.RESULTS Among 95 IIM-IIP patients,52 cases had pulmonary infection,the incidence of pulmonary infection was 54.74%.A total of 59 strains of pathogenic bacteria were isolated,among which the proportion of gram-negative bacteria,gram-positive bacteria,fungi,cytomegalovirus and mycoplasma pneumoniae were 45.76%,28.81%,20.34%,3.39%,1.69%,respectively.Gram-negative bacteria were mainly Pseudmonas aeruginosa(11 strains),gram-positive bacteria were mainly Streptococcus pneumoniae(7 strains).Multivariate logistic regression analysis showed that peripheral blood lymphocyte count,CD_(4)^(+)/CD_(8)^(+),serum albumin,lactate dehydrogenase(LDH)were risk factors for pul-monary infection in patients with IIM-IIP(P<0.05).CONCLUSION The incidence of pulmonary infection in pa-tients with IIM-IIP is high,and the pathogenic bacteria are mainly gram-negative bacteria.Pulmonary infection in IIM-IIP patients is closely related to peripheral blood lymphocyte count,CD_(4)^(+)/CD_(8)^(+),albumin and LDH.Therefore,early targeted prevention and treatment should be used to reduce the risk for pulmonary infection in patients with IIM-IIP.

关 键 词：特发性炎性肌病间质性肺炎 肺部感染 病原菌 危险因素 预防措施 

分 类 号：R563.1[医药卫生—呼吸系统]