慢性阻塞性肺疾病并发持续喘息的临床研究
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摘要
目的:探讨慢性阻塞性肺疾病患者并发持续喘息与痰真菌培养阳性之间的相关性;探讨慢性阻塞性肺疾病患者痰真菌培养阳性的危险因素。
方法:收集2005年1月1日至2007年12月31日期间于上海市第一人民医院、中山医院、华东医院呼吸科就诊住院的符合入选标准的病例组和对照组患者的病史资料进行回顾性分析。
结果:共收集到符合入选标准的病例组35例,对照组43例。两组患者的痰病原学检测结果不同,病例组35例中32例(91.4%)痰真菌培养阳性,而对照组43例中11例(25.6%)痰真菌培养阳性,两组比较差异显著(P=0.000);相关分析提示痰真菌培养阳性和持续喘息间存在相关性(r=0.658,P=0.000),痰真菌培养阳性是持续喘息的危险因素(OR=31.030,95%CI: 7.905~121.799)。在真菌的菌种构成方面,病例组32例中曲霉菌12例,对照组11例中未检出曲霉菌,曲霉菌在两组中分布差异有统计学意义(P<0.05)。病例组中抗真菌治疗在症状缓解方面较未抗真菌治疗者差异有统计学意义(P<0.05)。以痰真菌培养结果分组,痰真菌培养阳性组与阴性组在性别、年龄、糖尿病史、吸烟史、雾化吸入史、累计口服糖皮质激素及是否有糖皮质激素吸入史方面差异无统计学意义(P>0.05),在应用抗生素种类、抗生素使用时间、累计静脉使用糖皮质激素剂量和糖皮质激素使用时间等方面差异显著(P<0.01)。多因素分析提示抗生素和糖皮质激素使用时间长及静脉大量使用糖皮质激素是痰真菌培养阳性的危险因素(P<0.05)。
结论:慢性阻塞性肺疾病患者并发持续喘息与真菌在气道内持续存在相关。长期大量糖皮质激素的使用及长期广谱、超广谱抗生素的联合使用或更换过于频繁是下呼吸道真菌持续存在的危险因素。
Objective: To analyze the morbidity, clinical manifestation and the etiology of the persistent wheezing in patients with chronic obstructive pulmonary disease and the risk factors of the positive result in the fungi culture of the sputum.
Methods: The case data met the recruit criteria was collected from patients diagnosed and hospitalized in the respiratory departments of the Shanghai First People’s Hospital, Zhongshan Hospital and Huadong Hospital from Jan 2005 to Dec 2007. A retrospective study was taken to analyze the case-control study.
Results: During the period, 35 cases were collected in the case group and 43 cases in the control group; 32 (91.4%) cases with persistent wheezing more than 4 weeks in the case group had positive sputum culture of fungi, while in the control group there were 11 (25.6%) cases had the positive result; The difference of the results of sputum culture of fungi between 2 groups was significant (P=0.000),and the persistent wheezing significantly correlated with the positive sputum culture of fungi (r=0.658,P=0.000, OR=31.030, 95%CI: 7.905~121.799). The composition of fungi was significantly different in 2 groups (P<0.05). In the case group, patients with antifungal treatment showed better prognosis than those without the treatment. There were no significant differences in sex, age , history of smoking , diabetes and atomization inhalation, and the accumulated doses of oral corticosteroids between the fungi culture positive group and the fungi culture negative group (P>0.05), while the differences in the species and days of the use of antibiotics and the accumulated doses of intravenous corticosteroids were significant (P<0.01); The logistic analysis showed that prolonged high-dose of corticosteroids and multiple broad-spectrum antibiotics were risk factors of positive sputum culture of fungi (P<0.05).
Conclusion: The persistent wheezing in the patients of COPD is correlated with the existence of fungi in the airway. Prolonged high-dose of corticosteroids and multiple broad-spectrum antibiotics are risk factors of positive sputum culture of fungi in the patients of COPD.
方法:收集2005年1月1日至2007年12月31日期间于上海市第一人民医院、中山医院、华东医院呼吸科就诊住院的符合入选标准的病例组和对照组患者的病史资料进行回顾性分析。
结果:共收集到符合入选标准的病例组35例,对照组43例。两组患者的痰病原学检测结果不同,病例组35例中32例(91.4%)痰真菌培养阳性,而对照组43例中11例(25.6%)痰真菌培养阳性,两组比较差异显著(P=0.000);相关分析提示痰真菌培养阳性和持续喘息间存在相关性(r=0.658,P=0.000),痰真菌培养阳性是持续喘息的危险因素(OR=31.030,95%CI: 7.905~121.799)。在真菌的菌种构成方面,病例组32例中曲霉菌12例,对照组11例中未检出曲霉菌,曲霉菌在两组中分布差异有统计学意义(P<0.05)。病例组中抗真菌治疗在症状缓解方面较未抗真菌治疗者差异有统计学意义(P<0.05)。以痰真菌培养结果分组,痰真菌培养阳性组与阴性组在性别、年龄、糖尿病史、吸烟史、雾化吸入史、累计口服糖皮质激素及是否有糖皮质激素吸入史方面差异无统计学意义(P>0.05),在应用抗生素种类、抗生素使用时间、累计静脉使用糖皮质激素剂量和糖皮质激素使用时间等方面差异显著(P<0.01)。多因素分析提示抗生素和糖皮质激素使用时间长及静脉大量使用糖皮质激素是痰真菌培养阳性的危险因素(P<0.05)。
结论:慢性阻塞性肺疾病患者并发持续喘息与真菌在气道内持续存在相关。长期大量糖皮质激素的使用及长期广谱、超广谱抗生素的联合使用或更换过于频繁是下呼吸道真菌持续存在的危险因素。
Objective: To analyze the morbidity, clinical manifestation and the etiology of the persistent wheezing in patients with chronic obstructive pulmonary disease and the risk factors of the positive result in the fungi culture of the sputum.
Methods: The case data met the recruit criteria was collected from patients diagnosed and hospitalized in the respiratory departments of the Shanghai First People’s Hospital, Zhongshan Hospital and Huadong Hospital from Jan 2005 to Dec 2007. A retrospective study was taken to analyze the case-control study.
Results: During the period, 35 cases were collected in the case group and 43 cases in the control group; 32 (91.4%) cases with persistent wheezing more than 4 weeks in the case group had positive sputum culture of fungi, while in the control group there were 11 (25.6%) cases had the positive result; The difference of the results of sputum culture of fungi between 2 groups was significant (P=0.000),and the persistent wheezing significantly correlated with the positive sputum culture of fungi (r=0.658,P=0.000, OR=31.030, 95%CI: 7.905~121.799). The composition of fungi was significantly different in 2 groups (P<0.05). In the case group, patients with antifungal treatment showed better prognosis than those without the treatment. There were no significant differences in sex, age , history of smoking , diabetes and atomization inhalation, and the accumulated doses of oral corticosteroids between the fungi culture positive group and the fungi culture negative group (P>0.05), while the differences in the species and days of the use of antibiotics and the accumulated doses of intravenous corticosteroids were significant (P<0.01); The logistic analysis showed that prolonged high-dose of corticosteroids and multiple broad-spectrum antibiotics were risk factors of positive sputum culture of fungi (P<0.05).
Conclusion: The persistent wheezing in the patients of COPD is correlated with the existence of fungi in the airway. Prolonged high-dose of corticosteroids and multiple broad-spectrum antibiotics are risk factors of positive sputum culture of fungi in the patients of COPD.
引文
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[19]中华内科杂志编辑委员会. 侵袭性肺部真菌感染的诊断标准与治疗原则(草案) [ J ]. 中华内科杂志, 2006, 45: 697 -700
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