慢性阻塞性肺疾病急性加重期继发真菌感染的临床相关因素分析

发布时间：2018-08-08 11:41

【摘要】：目的探讨慢性阻塞性肺疾病(COPD)急性加重期继发真菌感染的危险因素、临床特征,为肺部真菌感染的早期预防和诊断提供临床依据。方法回顾性分析2011年1-12月收治的794例COPD急性加重期住院患者的临床资料。结果 794例患者中继发真菌感染140例,感染率17.63%;140例真菌感染患者检出白色假丝酵母菌占36.43%,曲霉菌属占21.43%;高龄、住院时间长、合并多种其他基础疾病(糖尿病)、既往侵袭性真菌感染病史、低蛋白血症、长期住ICU,长时间体内留置导管、有创机械通气以及广谱抗菌药物使用为继发真菌感染的重要危险因素;好转及痊愈117例占83.57%,无效10例占7.14%,死亡13例,病死率9.29%。结论 COPD继发真菌感染病死率较高,对于高危人群进行有效治疗、合理使用广谱抗菌药物和糖皮质激素、减少侵入性操作、重视病原学标本的采集,做出早期诊断并及时抗真菌治疗,可改善预后、降低病死率。
[Abstract]:Objective to explore the risk factors and clinical features of fungal infection secondary to (COPD) in acute exacerbation of chronic obstructive pulmonary disease (COPD), and to provide clinical basis for early prevention and diagnosis of pulmonary fungal infection. Methods the clinical data of 794 patients with acute exacerbation of COPD from January to December 2011 were analyzed retrospectively. Results among the 794 patients, 140 cases were secondary fungal infection, and the infection rate was 17.630.140 cases of fungal infection had detected Candida albicans 36.43, Aspergillus 21.43 and Aspergillus 21.43. Complicated with many other basic diseases (diabetes mellitus), previous invasive fungal infection history, hypoproteinemia, long-term residence in ICU, long time in vivo indwelling catheter, Invasive mechanical ventilation and use of broad-spectrum antibiotics were important risk factors for secondary fungal infection, 117 cases were improved and cured (83.57%), 10 cases were ineffective (7.14%), 13 cases died, and the mortality rate was 9.29%. Conclusion the mortality rate of secondary fungal infection in COPD is high. It is effective to treat high risk population, to use broad-spectrum antibiotics and glucocorticoid rationally, to reduce invasive operation and to attach importance to the collection of pathogenic specimens. Early diagnosis and timely antifungal therapy can improve prognosis and reduce mortality.
【作者单位】：北京市顺义区妇幼保健院;首都医科大学附属北京朝阳医院北京市呼吸疾病研究所北京市呼吸与肺循环疾病实验室;卫生部北京医院老年医学研究所;
【基金】：北京市科学技术委员会首都临床特色应用研究基金资助项目(Z111107058811002) 卫生部卫生公益性行业科研专项基金项目(201002008)
【分类号】：R563.9

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