慢性阻塞性肺疾病患者并发侵袭性肺曲霉病的影响因素研究
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摘要
目的：探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者并发侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)的影响因素，为临床防治提供更为科学的决策依据。
材料与方法：采用1：2配对病例对照研究。COPD并发IPA患者为病例组(共37例)，COPD患者为对照组(共74例)。回顾性分析111例患者的临床资料，将对疾病发生的可能影响因素(包括COPD病程、伴随疾病、住院时间、是否住入重症监护室(intensive care unit,ICU)、有无吸烟史、血清白蛋白水平、有无机械通气、有无侵入性操作、是否使用激素、激素总疗程、激素剂型用法、个人使用抗生素累积品种数、抗生素总疗程、抗生素单用/联用情况等14个因素)纳入单因素分析：定量资料的两组均数比较用t检验(正态分布)/两样本wilcoxon秩和检验(偏态分布)。分类资料的两组构成分布比较用四格表/行×列表X~2检验。以P＜0．05作为有统计学意义的判定标准。将初步筛选出的影响因素纳入多因素分析，采用二分类Logistic回归，以P＜0．05作为有统计学意义的判定标准，进一步筛选出疾病发生的主要影响因素。
结果：经单因素分析表明，住院时间、是否住入ICU、有无吸烟史、血清白蛋白水平、有无机械通气、有无侵入性操作、是否使用激素、激素总疗程、个人使用抗生素累积品种数、抗生素总疗程、抗生素单用/联用情况等11个因素是疾病发生的影响因素。经多因素分析表明，血清白蛋白水平、有无机械通气、有无侵入性操作、是否使用激素等4个因素是疾病发生的主要影响因素。
结论：COPD患者并发IPA是多种因素共同影响的结果。其中血清白蛋白水平、有无侵入性操作、有无机械通气、是否使用激素等4个因素是对疾病发生影响较大的因素。
Objectives: To investigate the influencing factors for chronic obstructive pulmonary disease (COPD) patients complicated with invasive pulmonary aspergillosis (IPA).
Materials and Methods: 111 patients were enrolled in this study. 37 patients who suffered from COPD complicated with IPA served as case group, another 74 COPD patients without IPA as control group. The clinical data of those 111 patients were analysed retrospectively. The possible influencing factors were measured as followings: COPD course, concomitant diseases, duration in hospital, intensive care unit (ICU), smoking history, plasma albumin level, mechanical ventilation, invasive procedure, use of glucocortocoids and antibiotics. In univariate analysis, numerical variables were compared by t test (normal distribution) or Wilcoxon rank test (skewed distribution) and categorical variables by X~2 test. Those variables with P values less than 0.05 were analysed by binary Logistic regression model in multivariate analysis.
Results: According to univariate analysis, the influencing factors for COPD patients complicated with IPA included: duration in hospital, ICU, smoking history, plasma albumin level, mechanical ventilation, invasive procedure, use of glucocortocoids and antibiotics. Multivariate analysis indicated that plasma albumin level, mechanical ventilation, invasive procedure, and use of glucocortocoids were main influencing factors for those patients.
Conclusions: COPD patients complicated with IPA were influenced by many factors. The main influencing factors included: plasma albumin level, mechanical ventilation, invasive procedure, and use of glucocortocoids.
材料与方法：采用1：2配对病例对照研究。COPD并发IPA患者为病例组(共37例)，COPD患者为对照组(共74例)。回顾性分析111例患者的临床资料，将对疾病发生的可能影响因素(包括COPD病程、伴随疾病、住院时间、是否住入重症监护室(intensive care unit,ICU)、有无吸烟史、血清白蛋白水平、有无机械通气、有无侵入性操作、是否使用激素、激素总疗程、激素剂型用法、个人使用抗生素累积品种数、抗生素总疗程、抗生素单用/联用情况等14个因素)纳入单因素分析：定量资料的两组均数比较用t检验(正态分布)/两样本wilcoxon秩和检验(偏态分布)。分类资料的两组构成分布比较用四格表/行×列表X~2检验。以P＜0．05作为有统计学意义的判定标准。将初步筛选出的影响因素纳入多因素分析，采用二分类Logistic回归，以P＜0．05作为有统计学意义的判定标准，进一步筛选出疾病发生的主要影响因素。
结果：经单因素分析表明，住院时间、是否住入ICU、有无吸烟史、血清白蛋白水平、有无机械通气、有无侵入性操作、是否使用激素、激素总疗程、个人使用抗生素累积品种数、抗生素总疗程、抗生素单用/联用情况等11个因素是疾病发生的影响因素。经多因素分析表明，血清白蛋白水平、有无机械通气、有无侵入性操作、是否使用激素等4个因素是疾病发生的主要影响因素。
结论：COPD患者并发IPA是多种因素共同影响的结果。其中血清白蛋白水平、有无侵入性操作、有无机械通气、是否使用激素等4个因素是对疾病发生影响较大的因素。
Objectives: To investigate the influencing factors for chronic obstructive pulmonary disease (COPD) patients complicated with invasive pulmonary aspergillosis (IPA).
Materials and Methods: 111 patients were enrolled in this study. 37 patients who suffered from COPD complicated with IPA served as case group, another 74 COPD patients without IPA as control group. The clinical data of those 111 patients were analysed retrospectively. The possible influencing factors were measured as followings: COPD course, concomitant diseases, duration in hospital, intensive care unit (ICU), smoking history, plasma albumin level, mechanical ventilation, invasive procedure, use of glucocortocoids and antibiotics. In univariate analysis, numerical variables were compared by t test (normal distribution) or Wilcoxon rank test (skewed distribution) and categorical variables by X~2 test. Those variables with P values less than 0.05 were analysed by binary Logistic regression model in multivariate analysis.
Results: According to univariate analysis, the influencing factors for COPD patients complicated with IPA included: duration in hospital, ICU, smoking history, plasma albumin level, mechanical ventilation, invasive procedure, use of glucocortocoids and antibiotics. Multivariate analysis indicated that plasma albumin level, mechanical ventilation, invasive procedure, and use of glucocortocoids were main influencing factors for those patients.
Conclusions: COPD patients complicated with IPA were influenced by many factors. The main influencing factors included: plasma albumin level, mechanical ventilation, invasive procedure, and use of glucocortocoids.
引文
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2．中华医学会呼吸病学会慢性阻塞性肺疾病学组．慢性阻塞性肺疾病诊治指南．中华结核和呼吸杂志，2002；25(8)：453-460
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