慢性阻塞性肺病曲霉菌痰培养阳性的多因素分析

发布时间：2018-03-31 09:16

本文选题：COPD急性加重　切入点：侵袭性肺曲霉菌病危险因素　出处：《青岛大学》2017年硕士论文

【摘要】：目的:研究慢性阻塞性肺疾病(COPD)患者发生呼吸道曲霉菌分离阳性以及发生侵袭性肺曲霉病(IPA)的危险因素,对痰曲霉菌涂片或培养阳性结果在IPA诊断中的作用进行再评价。方法:选择2014年1月至2015年1月期间住院治疗的慢性阻塞性肺病急性发作的207名患者中符合条件的95例为研究对象,其中52例呼吸道曲霉菌分离阳性患者,根据我国IPA的诊断标准进行分组,对比分析IPA组、非IPA组及痰菌阴性组在基础疾病、临床症状、既往治疗使用的药物及预后等方面进行回顾性分析。收集所有入选患者的临床资料,包括年龄、性别、合并疾病(糖尿病、肾功能不全、心功能不全等)、糖皮质激素使用情况、广谱抗生素使用情况、机械通气情况、血清白蛋白水平、既往真菌感染或定植史、过去1年的住院次数以及抗真菌治疗情况和预后。本研究中将长期使用糖皮质激素界定为全身应用相当于泼尼松剂量30 mg/d连续应用10 d以上或30 mg/d连续应用1个月以上。结果:确诊IPA及临床诊断IPA者25例,曲霉菌定植27例。单因素方差分析发现,长期使用糖皮质激素和广谱抗生素、机械通气、过去1年中多次住院、低蛋白血症、既往真菌感染或定植史等因素与COPD患者痰培养阳性有关,对比分析曲霉菌阳性患者中IPA与非IPA患者,结果示长期使用糖皮质激素和广谱抗生素、机械通气、过去1年中多次住院等因素与COPD患者发生IPA有关;多因素Logistic回归分析显示,长期使用糖皮质激素及过去一年中多次住院者是AECOPD曲霉菌痰培养阳性患者发生IPA的独立危险因素。IPA组住院病死率为84%,明显高于定植组22.2%,差异具有统计学意(P0.01)。对预后危险因素分析表明,延迟诊断和治疗与预后相关。将收集到的43例痰曲霉菌培养阴性患者与27例痰曲霉菌培养阳性非IPA患者进行对比分析,两组患者性别、年龄构成比、肾功能不全、心功能不全差异无统计学意义(P0.05),而糖尿病、使用激素、长期使用广谱抗生素、机械通气、过去1年中多次住院、低蛋白血症血症等因素差异有统计学意义。(P0.05)结论:长期使用糖皮质激素或广谱抗生素、糖尿病、机械通气、过去1年中多次住院、低蛋白血症、既往真菌感染或定植史是痰曲霉菌培养阳性的危险因素;反复使用糖皮质激素、过去一年中多次住院是COPD患者发生IPA的独立危险因素;痰曲霉菌培养阳性结合IPA发生的高危因素综合判断,可以作为IPA早期诊断、抢先抗曲霉治疗的依据。
[Abstract]:Objective: to study the risk factors of respiratory Aspergillus isolation positive and invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD), and to re-evaluate the role of sputum smear or culture positive results in the diagnosis of IPA.Methods: a total of 207 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) hospitalized from January 2014 to January 2015 were selected as subjects, including 52 patients with respiratory aspergillus positive.According to the diagnostic criteria of IPA in China, we compared and analyzed the basic diseases, clinical symptoms, drugs used in previous treatment and prognosis in IPA group, non-#en2# group and sputum negative group.Collect clinical data of all patients, including age, sex, complicated diseases (diabetes, renal insufficiency, cardiac insufficiency, etc.), use of glucocorticoids, use of broad-spectrum antibiotics, mechanical ventilation, etc.Serum albumin level, past fungal infection or colonization history, hospitalization times in the past year, antifungal treatment and prognosis.In this study, the long-term use of glucocorticoid was defined as the whole body application equivalent to prednisone 30 mg/d continuous use for more than 10 days or 30 mg/d continuous use for more than one month.Results: 25 cases of IPA were diagnosed by IPA and 27 cases were colonized by Aspergillus.Univariate analysis of variance showed that long-term use of glucocorticoids and broad-spectrum antibiotics, mechanical ventilation, multiple hospitalizations in the past year, hypoproteinemia, past fungal infection or colonization were associated with positive sputum culture in patients with COPD.The results showed that long-term use of glucocorticoid and broad-spectrum antibiotics, mechanical ventilation and multiple hospitalizations in the past year were associated with IPA in patients with COPD.Long-term use of glucocorticoid and multiple hospitalizations in the past year were independent risk factors for the occurrence of IPA in AECOPD Aspergillus sputum positive patients. The inpatient mortality in IPA group was 84%, which was significantly higher than that in colonization group (22. 2%), and the difference was statistically significant (P 0. 01).Analysis of prognostic risk factors showed that delayed diagnosis and treatment were associated with prognosis.43 sputum Aspergillus culture-negative patients and 27 sputum aspergillus culture-positive non-#en0# patients were compared and analyzed. There was no significant difference in sex, age ratio, renal insufficiency and cardiac insufficiency between the two groups, but there was no significant difference in diabetes mellitus.Use of hormone, long-term use of broad-spectrum antibiotics, mechanical ventilation, in the past year many times in hospital, hypoproteinemia and other factors have statistical significance (P 0.05) conclusion: long-term use of glucocorticoid or broad-spectrum antibiotics, diabetes, mechanical ventilation,In the past year, hypoproteinemia, previous fungal infection or colonization were the risk factors of sputum Aspergillus culture positive, and repeated use of glucocorticoid were independent risk factors for IPA in COPD patients.The comprehensive judgement of the high risk factors of sputum Aspergillus culture combined with the occurrence of IPA can be used as the basis for the early diagnosis of IPA and the preemptive treatment against Aspergillus.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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