COPD合并侵袭性肺曲霉菌病的危险因素及临床特点分析

发布时间：2018-05-03 10:22

本文选题：慢性阻塞性肺疾病 + 侵袭性肺曲霉菌病　；参考：《中国临床研究》2016年07期

【摘要】：目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)的危险因素及临床特点。方法收集2012年2月至2015年3月柳州市各医院住院接受治疗的960例COPD患者,其中COPD合并IPA 42例(感染组),剩余918例均为未合并IPA病例(非感染组)。分析COPD合并IPA的相关因素及其临床特点、治疗方法和疗效。结果 (1)单因素分析结果显示:感染组与非感染组在长期应用激素、合并糖尿病、机械通气、应用抗菌药物时间及血清白蛋白水平差异均具有统计学意义(P均0.01)。(2)经多元Logistic回归分析,影响COPD合并IPA相关因素包括:是否合并糖尿病、血清白蛋白水平及是否长期使用抗菌药物(P0.05,P0.01)。(3)感染组咳嗽咳痰、呼吸困难、发热、白细胞较正常升高或降低、C反应蛋白升高、GM实验阳性等临床症状发生率均高于非感染组(P0.05,P0.01)。(4)感染组病灶周围"晕征"、单发或者多发空洞、新月征发生率均高于非感染组(P均0.01)。(5)42例患者分别采用了卡泊芬净与伏立康唑进行治疗,治疗有效率均为83.33%。结论影响COPD合并IPA的相关因素有合并糖尿病、血清白蛋白水平及长期使用抗菌药物,应积极对危险因素加以干预;临床医师应该不断增强对该病的认识,对高危患者,应及时行痰培养、GM实验、胸部CT、病灶活检等检查,以达到尽早诊断,及时治疗,改善预后。
[Abstract]:Objective to investigate the risk factors and clinical features of chronic obstructive pulmonary disease (cad) with invasive pulmonary aspergillosis (IPA). Methods from February 2012 to March 2015, 960 patients with COPD were enrolled in the hospital in Liuzhou, 42 of them were COPD combined with IPA (infection group), the remaining 918 cases were uncomplicated IPA cases (non-infection group). To analyze the related factors, clinical characteristics, treatment methods and curative effect of COPD complicated with IPA. Results 1) the results of univariate analysis showed that: the infection group and the non-infection group were treated with hormone for a long time, complicated with diabetes, mechanical ventilation, There were statistically significant differences in the time of antibiotics and serum albumin levels (P < 0.01) by multivariate Logistic regression analysis, the factors related to COPD and IPA were as follows: diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus and diabetes mellitus. Serum albumin level and whether long-term use of antimicrobial agents P0.05, P0.01P0.01P0.01An) infection group cough expectoration, dyspnea, fever, The incidence of clinical symptoms, such as elevated or lower levels of leukocytes in patients with higher or lower levels of C reactive protein and positive GM test, was higher than that in the non-infected group (P0.05, P0.01P0.01P0.01P0.01U. 4) the "halo sign", single or multiple cavity, around the lesion in the infected group. The incidence rate of crescent sign was higher than that of non-infection group (P = 0.01). 542 patients were treated with carpofen and voleconazole respectively. The effective rate was 83.33. Conclusion the related factors affecting COPD complicated with IPA are diabetes mellitus, serum albumin level and long-term use of antimicrobial agents, which should be actively interfered with risk factors, and the clinicians should constantly enhance their understanding of the disease and treat high risk patients. In order to make early diagnosis, timely treatment and improve prognosis, we should do the GM test of sputum culture, chest CTS and biopsy in time.
【作者单位】：广西科技大学第一附属医院呼吸科;
【基金】：广西壮族自治区卫生厅科研课题(z2012605)
【分类号】：R563.9;R519

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