重症颅脑损伤患者并发肺部真菌感染病原学分布及危险因素研究  

Pathogenic distribution and risk factors of invasive pulmonary fungal infection in patients with severe craniocerebral injury

作　　者：徐云 张莉 XU Yun;ZHANG Li(Department of Emergency,The First Affiliated Hospital of PLA Air Force Medical University,Xi'an 710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院急诊科,西安710032

出　　处：《中国真菌学杂志》2024年第4期331-336,共6页Chinese Journal of Mycology

摘　　要：目的探讨重症颅脑损伤(severe craniocerebral injury,SCCI)患者并发侵袭性肺部真菌感染(invasive pulmonary fungal infection,IPFI)的病原学分布及危险因素,以期为改善SCCI预后提供科学依据。方法纳入中国人民解放军空军军医大学第一附属医院急诊科2019年9月1日—2023年8月31日收治的SCCI患者160例,根据其是否并发IPFI分为感染组(n=63)和未感染组(n=97)。统计感染组真菌分布情况,比较两组临床资料,采用logistic回归分析SCCI患者并发IPFI的危险因素,根据受试者工作特征曲线评估预测变量准确性。结果感染组共检测出63株病原真菌,以白念珠菌(73.02%)为主。logistic多因素分析显示,年龄≥65岁(OR=3.701)、糖尿病(OR=11.782)、气管切开辅助通气时间(OR=1.440)、抗生素应用时间(OR=2.221)、血清白细胞介素17(IL-17)水平(OR=1.647)是影响SCCI患者并发IPFI的独立危险因素(P<0.05)。受试者工作特征曲线分析显示:联合预测评估IPFI的曲线下面积(AUC)=0.951,95%CI为0.916~0.987,灵敏度为0.873,特异度为0.948;与曲线下面积为0.5相比,差异具有统计学意义(P<0.05)。结论SCCI并发IPFI的主要致病菌种为念珠菌,年龄≥65岁、糖尿病、气管切开辅助通气时间、抗生素应用时间、血清IL-17水平均为SCCI并发IPFI的独立危险因素。Objective To investigate the etiological distribution and risk factors of invasive pulmonary fungal infection(IPFI)in patients with severe craniocerebral injury(SCCI),in order to provide scientific basis for improving the prognosis of SCCI.Methods A total of 160 patients with SCCI admitted to the Emergency Department of the First Affiliated Hospital of the PLA Air Force Medical University from September 1,2019 to August 31,2023 were divided into infected group(n=63)and uninfected group(n=97)according to whether they had concurrent IPFI.The distribution of fungi in the infected group was statistically analyzed,and the clinical data of the two groups were compared.The risk factors of concurrent IPFI in SCCI patients were analyzed by logistic regression,and the accuracy of predictive variables was evaluated according to receiver operating characteristics(ROC)curve.Results 63 pathogenic fungi were detected in the infection group,mainly Candida albicans(73.02%).Logistic multivariate analysis showed that age≥65 years(OR=3.701),diabetes mellitus(OR=11.782),tracheotomy assisted ventilation time(OR=1.440),antibiotic application time(OR=2.221),and serum interleukin 17(IL-17)level(OR=1.647)were independent risk factors for IPFI in patients with SCCI vegetarian(P<0.05).ROC analysis showed that the region under the curve(AUC)of joint prediction evaluation of IPFI was 0.951,95%CI was 0.916-0.987,sensitivity was 0.873,specificity was 0.948.Compared with the area under the curve of 0.5,the difference was statistically significant(P<0.05).Conclusion The main pathogen of SCCI complicated with IPFI is Candida.Age≥65 years old,diabetes mellitus,tracheotomy assisted ventilation time,antibiotic application time and serum IL-17 level are all independent risk factors for SCCI complicated with IPFI.

关 键 词：重症颅脑损伤 重症监护 肺部感染 真菌分布 危险因素 

分 类 号：R519[医药卫生—内科学]