肠杆菌社区获得性肺炎的临床特征和预后因素分析

发布时间：2018-11-17 14:37

【摘要】：目的探讨肠杆菌社区获得性肺炎(EnCAP)的临床特征和影响30d病死率的因素。方法回顾性分析我院2010年至2015年收治的EnCAP 237例和肺炎链球菌社区获得性肺炎(SpCAP)120例,比较两组的人口学、基础病、临床症状体征、相关实验室检查和影像学,以及治疗和预后。单因素分析和Logistic回归分析影响EnCAP 30d病死率的危险因素。结果和SpCAP组相比,EnCAP组脑血管疾病(19.8%比8.3%)、慢性肝病(8.4%比1.7%)、慢性肾病(5.1%比0.0%)、吸入因素(11.0%比0.0%)比例高,PSI分级(2.9±1.3比2.5±0.8)/CURB-65评分(1.1±0.1比0.6±0.4)更高;意识改变(12.2%比0.0%)常见,血白细胞计数[(9.5±5.7)×10~9/L比(10.4±4.8)×10~9/L]、血红蛋白[(125.0±9.0)g/L比(135.0±15.0)g/L]、白蛋白[(32.0±8.0)g/L比(36.0±9.4)g/L]水平低,合并胸腔积液者(30.4%比12.5%)更常见;在合理经验性抗感染治疗比例接近的条件下,两者临床结局类似,但EnCAP住院时间更长(12.0d比7.0d)。Logistic回归分析证实血红蛋白(OR0.087,95%CI0.857~0.981)、合理的经验性抗感染治疗(OR 0.108,95%CI 0.011~0.151)和脓毒性休克(OR1.700,95%CI0.781~38.326)是影响EnCAP 30d病死率的独立危险因素。结论 EnCAP的临床表现不同于SpCAP。脓毒性休克是EnCAP 30d死亡的独立危险因素,血红蛋白与合理的经验性抗感染治疗是保护因素,能够降低30d病死率。
[Abstract]:Objective to investigate the clinical features of Enterobacter communis acquired pneumonia (EnCAP) and the factors influencing 30 d mortality. Methods A retrospective analysis was made in 237 cases of EnCAP and 120 cases of streptococcus pneumoniae community acquired pneumonia (SpCAP) admitted in our hospital from 2010 to 2015. The demographics, basic diseases, clinical symptoms and signs, laboratory examination and imaging were compared between the two groups. Treatment and prognosis. Univariate analysis and Logistic regression analysis were used to analyze the risk factors of EnCAP 30 d mortality. Results compared with SpCAP group, EnCAP group had cerebrovascular disease (19.8% vs 8.3%), chronic liver disease (8.4% vs 1.7%) and chronic nephropathy (5.1% vs 0.0%). The proportion of inhaled factors (11.0% vs 0.0%) was higher than that of PSI grade (2.9 卤1.3 vs 2.5 卤0.8) / CURB-65 score (1.1 卤0.1 vs 0.6 卤0.4). Changes in consciousness were common (12.2% vs 0.0%), WBC count [(9.5 卤5.7) 脳 10 ~ (9) / L vs (10.4 卤4.8) 脳 10 ~ (9) / L], hemoglobin [(125.0 卤9.0) g / L vs (135.0 卤15.0) g / L], The level of albumin [(32.0 卤8.0) g / L] was lower than that of (36.0 卤9.4) g / L, especially in patients with pleural effusion (30.4% vs 12.5%). When the proportion of rational empirical anti-infective therapy was close, the clinical outcome was similar, but the hospitalization time of EnCAP was longer (12.0d vs 7.0d). Logistic regression analysis confirmed hemoglobin (OR0.087,95%CI0.857~0.981). Rational empirical anti-infective therapy (OR 0.108 CI 0.0110.151) and septic shock (OR1.700,95%CI0.781~38.326) were independent risk factors for the 30-day mortality of EnCAP. Conclusion the clinical manifestation of EnCAP is different from that of SpCAP.. Septic shock was an independent risk factor for death in EnCAP for 30 days. Hemoglobin and rational empirical antiinfective therapy were protective factors and could reduce the mortality of 30 days.
【作者单位】：北京积水潭医院感染疾病科;
【分类号】：R563.1

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