COVID-19相关性肺曲霉病41例临床分析  

Clinical analysis of 41 cases of COVID-19-associated pulmonary aspergillosis

作　　者：张海宁 刘本洪 孙杨 马君 秦金光 董新新 于佳 ZHANG Hai-ning;LIU Ben-hong;SUN Yang;MA Jun;QIN Jin-guang;DONG Xin-xin;YU Jia(Department of Respiratory and Critical Care Medicine,Dongying People's Hospital,Dongying 257000,Shandong,CHINA)

机构地区：[1]东营市人民医院呼吸与危重症医学科,山东东营257000

出　　处：《海南医学》2024年第20期2929-2934,共6页Hainan Medical Journal

摘　　要：目的探讨COVID-19相关性肺曲霉病(CAPA)的危险因素、临床特点,以提高对该病的认识。方法收集2022年12月至2023年5月间在东营市人民医院呼吸与危重症医学科住院治疗的41例CAPA患者作为CAPA组,随机选取同期住院的COVID-19但未继发肺曲霉病的41例患者为对照组。比较两组患者的临床资料,采用单因素和多因素的条件Logistic回归分析CAPA的危险因素。结果CAPA组患者的住院天数为20(12,27)d,明显长于对照组的12(9,14)d,新冠重症患者占比48.8%,明显高于对照组的22.0%,死亡率为19.5%,明显高于对照组的4.9%,差异均有统计学意义(P<0.05);COVID-19合并结构性肺病、糖尿病、心血管疾病、呼吸衰竭、低蛋白血症患者更易继发曲霉菌感染;与对照组比较,CAPA组患者咳嗽咳痰、气短、体质量减轻更多见,差异均有统计学意义(P<0.05);与对照组比较,CAPA组患者的淋巴细胞计数、白蛋白、氧合指数更低,C-反应蛋白、白介素-6、乳酸脱氢酶水平更高,差异均有统计学意义(P<0.05);CAPA患者的影像学表现以气道侵袭为主,表现为结节(41.5%)、斑片影(78.5%)、实变(70.7%);CAPA组患者以烟曲霉感染(90.2%)为主,其次为黑曲霉、黄曲霉;CAPA组患者BALF GM试验阳性率为63.6%,明显高于血清的22.0%,差异有显著统计学意义(P<0.01);CAPA组患者在应用全身糖皮质激素(85.4%)、托珠单抗(39.0%)、广谱抗生素(85.4%)、抗生素使用超过2周(70.7%)的比例明显高于对照组,差异均有统计学意义(P<0.05);多因素条件Logistic分析结果显示,新型冠状病毒感染重型、呼吸衰竭、低蛋白血症、应用糖皮质激素、应用托珠单抗、应用广谱抗生素、抗生素使用超过两周均是CAPA的独立危险因素(P<0.05)。结论COVID-19患者合并结构性肺病、糖尿病、心血管疾病时易继发肺曲霉病;CAPA临床表现无特异性,胸部CT以气道侵袭的非特异性征象为主,低蛋白血症、呼吸衰竭及应用Objective To investigate the risk factors and clinical characteristics of Corona Virus Disease-2019(COVID-19)-associated pulmonary aspergillosis(CAPA)in order to improve the understanding of the disease.Methods A total of 41 patients with CAPA from December 2022 to May 2023 in the Department of Respiratory and Critical Care Medicine,Dongying People's Hospital were selected as the CAPA group,and 41 patients with COVID-19 who were hospitalized during the same period but did not develop secondary pulmonary aspergillosis were randomly selected as the control group.The clinical data of the two groups were compared,and the risk factors of CAPA were analyzed by univariate and multivariate conditional logistic regression.Results The length of hospital stay in CAPA group was 20(12,27)days,which was significantly longer than 12(9,14)days in the control group;the proportion of severe COVID-19 patients accounted for 48.8%,which was significantly higher than 22.0%in the control group;the mortality rate was 19.5%,which was significantly higher than 4.9%in the control group;the differences were statistically significant(P<0.05).COVID-19 combined with structural lung disease,diabetes,cardiovascular disease,respiratory failure,hypoproteinemia is more likely to cause secondary Aspergillus infection.Compared with the control group,cough expectoration,shortness of breath,and weight loss were more common in CAPA group,with statistically significant differences(P<0.05).Compared with the control group,lymphocyte count,albumin and oxygenation index were lower in CAPA group,while C-reactive protein,interleukin-6,and lactate dehydrogenase levels were significantly higher(P<0.05).The imaging manifestations of CAPA patients were mainly airway invasion,such as nodules(41.5%),plaques(78.5%),and consolidation(70.7%).Patients were mainly infected by Aspergillus fumigatus(90.2%)in CAPA group,followed by Aspergillus niger and Aspergillus flavus.The positive rate of BALF GM test(63.6%)in CAPA group was significantly higher than that in serum(22.0%

关 键 词：COVID-19相关性肺曲霉病 侵袭性肺曲霉病 靶向病原测序 临床特点 危险因素 

分 类 号：R511[医药卫生—内科学]