慢性阻塞性肺疾病急性加重期患者医院真菌感染危险因素分析
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摘要
目的分析慢性阻塞性肺疾病急性加重期(AECOPD)真菌感染的危险因素,并探讨其临床治疗措施。方法选取2017年1-12月医院收治的200例AECOPD患者,根据是否继发真菌感染分为非感染组(110例)和感染组(90例),分析医院真菌感染的高危因素,对发生真菌感染者按照随机数字表法分为对照组(45例)和研究组(45例),对照组患者采用氟康唑治疗,研究组患者采用卡泊芬净治疗,比较两种不同治疗方案的治疗效果。结果单因素分析发现,感染组中机械通气、ICU入住时间过长、长期使用激素和抗菌药物以及低蛋白血症患者比例均高于非感染组(P<0.05);多因素Logistic分析发现,机械通气、ICU入住时间过长、长期使用激素和抗菌药物以及低蛋白血症是AECOPD真菌感染的独立危险因素;采用卡泊芬净治疗的临床治疗总有效率高于氟康唑治疗(χ2=11.852,P<0.001)。结论机械通气、ICU入住时间过长、长期使用激素和抗菌药物以及低蛋白血症等是引发AECOPD患者发生真菌感染的高危因素,采用卡泊芬净治疗有助于提高AECOPD真菌感染临床治疗效果。
OBJECTIVE To investigate the risk factors for fungal infection in the patients with acute exacerbation of chronic obstructive pulmonary diseases(AECOPD).METHODS A total of 200 patients with AECOPD who were treated in the hospital from Jan 2017 to Dec 2017 were enrolled in the study and divided into the non-infection group with 110 cases and the infection group with 90 cases according to the status of secondary fungal infection,the high risk factors for the fungal infection were analyzed,the patients with fungal infection were randomly divided into the control group with 45 cases and the study group with 45 cases.The control group was treated with fluconazole,the study group was treated with caspofungin,and the curative effects were observed and compared between the two groups of patients.RESULTS Univariate analysis showed that the proportions of the patients with mechanical ventilation,long length of ICU stay,long-term use of hormones and antibiotics and hypoproteinemia were significantly higher in the infection group than in the non-infection group(P<0.05).Multivariate logistic analysis indicated that the mechanical ventilation,long length of ICU stay,long-term use of hormones and antibiotics and hypoproteinemia were the independent risk factors for the fungal infection in the patients with AECOPD.The total effective rate of clinical treatment of caspofungin was significantly higher than that of fluconazole(χ~2=11.852,P<0.001).CONCLUSIONThe mechanical ventilation,long length of ICU stay,long-term use of antibiotics and hormones and hypoproteinemia are the high risk factors for the fungal infection in the patients with AECOPD,and caspofungin can achieve remarkable effect on clinical treatment of the AECOPD patients with fungal infection.
OBJECTIVE To investigate the risk factors for fungal infection in the patients with acute exacerbation of chronic obstructive pulmonary diseases(AECOPD).METHODS A total of 200 patients with AECOPD who were treated in the hospital from Jan 2017 to Dec 2017 were enrolled in the study and divided into the non-infection group with 110 cases and the infection group with 90 cases according to the status of secondary fungal infection,the high risk factors for the fungal infection were analyzed,the patients with fungal infection were randomly divided into the control group with 45 cases and the study group with 45 cases.The control group was treated with fluconazole,the study group was treated with caspofungin,and the curative effects were observed and compared between the two groups of patients.RESULTS Univariate analysis showed that the proportions of the patients with mechanical ventilation,long length of ICU stay,long-term use of hormones and antibiotics and hypoproteinemia were significantly higher in the infection group than in the non-infection group(P<0.05).Multivariate logistic analysis indicated that the mechanical ventilation,long length of ICU stay,long-term use of hormones and antibiotics and hypoproteinemia were the independent risk factors for the fungal infection in the patients with AECOPD.The total effective rate of clinical treatment of caspofungin was significantly higher than that of fluconazole(χ~2=11.852,P<0.001).CONCLUSIONThe mechanical ventilation,long length of ICU stay,long-term use of antibiotics and hormones and hypoproteinemia are the high risk factors for the fungal infection in the patients with AECOPD,and caspofungin can achieve remarkable effect on clinical treatment of the AECOPD patients with fungal infection.
引文
[1]段玉香,范晔,杨海峰,等.慢性阻塞性肺疾病急性加重期患者肺部真菌感染对血清炎症因子的影响[J].中华医院感染学杂志,2017,27(4):754-757.
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[17]Kim HC,Choi SH,Huh JW,et al.Different pattern of viral infections and clinical outcomes in patient with acute exacerbation of chronic obstructive pulmonary disease and chronic obstructive pulmonary disease with pneumonia[J].J Med Virol,2016,88(12):2092-2099.
[18]樊黎丽,孟泳,赵润杨.老年慢性阻塞性肺疾病患者继发真菌感染的研究分析[J].中华医院感染学杂志,2015,25(9):2035-2037.
[19]秦玉梅.慢性阻塞性肺疾病急性加重期患者肺部感染现状及高危因素分析[J].护理实践与研究,2018,15(3):6-8.
[20]Wu Y,Xu H,Li L,et al.Susceptibility to Aspergillus infections in rats with chronic obstructive pulmonary disease via deficiency function of alveolar macrophages and impaired activation of TLR2[J].Inflammation,2016,39(4):1310-1318.
[21]Rohde G,Welte T.Pseudomonas aeruginosainfections in chronic obstructive pulmonary disease:role of long-term antibiotic treatment[J].Internist(Berl),2017,58(11):1142-1149.
[22]钟风芳,冯月娟,陈三峰.氟康唑预防重度慢性阻塞性肺疾病患者真菌感染的效果研究[J].中华医院感染学杂志,2015,25(10):2219-2221.
[23]Mallia P,Webber J,Gill SK,et al.Role of airway glucose in bacterial infections in patients with chronic obstructive pulmonary disease[J].J Allergy Clin Immunol,2018,142(3):815-823.
[24]石卫霞,林英翔,梁立荣,等.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[J].中华医院感染学杂志,2014,24(17):4243-4244,4247.
[25]陈新芝,张亚飞.伊曲康唑在慢性阻塞性肺疾病合并真菌感染治疗的疗效评价[J].临床肺科杂志,2017,22(5):868-870.
[26]玛依拉·阿不都克力木,迪丽努尔·买买提伊明,师帅.慢性阻塞性肺疾病急性加重期患者肺部真菌感染的影响因素研究[J].实用心脑肺血管病杂志,2017,25(5):44-47.
[27]王蕾,毛毅敏,张剑青,等.支气管肺泡灌洗液与血清G试验对AECOPD并发侵袭性肺部真菌感染患者诊断及治疗指导价值分析[J].中华医院感染学杂志,2016,26(22):5116-5118.
[2]陈健雄,陈应松.慢性阻塞性肺疾病合并呼吸衰竭患者发生真菌感染的相关因素分析[J].心肺血管病杂志,2016,35(6):467-468.
[3]郭晓斌,冯可青,赵丽敏,等.慢性阻塞性肺疾病急性加重期患者肺部真菌感染的相关因素分析[J].中华医院感染学杂志,2018,28(9):1313-1315,1323.
[4]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中国医学前沿杂志(电子版),2014,6(2):67-80.
[5]曹雪如.老年慢性阻塞性肺疾病合并真菌感染的相关危险因素分析[J].中国综合临床,2015,31(1):36-38.
[6]Nikolic E,Brandmajer T,Bokan V,et al.Prevalence of Escherichia coli resistant to beta-lactam antibiotics among patients with chronic obstructive pulmonary disease and urinary tract infection[J].Tohoku J Exp Med,2018,244(4):271-277.
[7]Protasov AD,Zhestkov AV,Kostinov MP,et al.Analysis of the effectiveness and long-term results of formation of adaptive immunity in the use of various medications and vaccination schemes against pneumococcal infection in patients with chronic obstructive pulmonary disease[J].Ter Arkh,2017,89(12.Vyp.2):165-174.
[8]Li Y,Xie L,Xin S,et al.Values of procalcitonin and C-reactive proteins in the diagnosis and treatment of chronic obstructive pulmonary disease having concomitant bacterial infection[J].Pak J Med Sci,2017,33(3):566-569.
[9]崔瑶,王云,秦明照,等.老年慢性阻塞性肺疾病合并下呼吸道真菌感染的临床特点分析[J].中华医院感染学杂志,2014,24(6):1397-1399.
[10]Tovt-Korshyns′ka MI,Blaha OS,Pudakova SO,et al.Pulmonary rehabilitation methods in the prevention of acute respiratory infections in patients with chronic obstructive pulmonary disease,the association with psycho-emotional state[J].Wiad Lek,2014,67(2Pt 2):264-265.
[11]Murphy TF,Brauer AL,Johnson A,et al.A cation-binding surface protein as a vaccine antigen to prevent Moraxella catarrhalis otitis media and infections in chronic obstructive pulmonary disease[J].Clin Vaccine Immunol,2017,pii:CVI.00130-17.
[12]尤志新,金英.慢性阻塞性肺疾病继发真菌感染的研究进展[J].贵阳中医学院学报,2014,36(6):139-140.
[13]Hewitt R,Farne H,Ritchie A,et al.The role of viral infections in exacerbations of chronic obstructive pulmonary disease and asthma[J].Ther Adv Respir Dis,2016,10(2):158-174.
[14]Gallo MC,Kirkham C,Eng S,et al.Changes in IgA protease expression are conferred by changes in genomes during persistent infection by nontypeable Haemophilus influenzae in chronic obstructive pulmonary disease[J].Infect Immun,2018,86(8).pii:e00313-18.
[15]Homma T,Kawahara T,Mikuni H,et al.Beneficial effect of early intervention with garenoxacin for bacterial infectioninduced acute exacerbation of bronchial asthma and chronic obstructive pulmonary disease[J].Int Arch Allergy Immunol,2019:1-8.
[16]Moleres J,Fernandez-Calvet A,Ehrlich RL,et al.Antagonistic pleiotropy in the bifunctional surface protein FadL(OmpP1)during adaptation of Haemophilus influenzae to chronic lung infection associated with chronic obstructive pulmonary disease[J].MBio,2018,9(5).pii:e01176-18.
[17]Kim HC,Choi SH,Huh JW,et al.Different pattern of viral infections and clinical outcomes in patient with acute exacerbation of chronic obstructive pulmonary disease and chronic obstructive pulmonary disease with pneumonia[J].J Med Virol,2016,88(12):2092-2099.
[18]樊黎丽,孟泳,赵润杨.老年慢性阻塞性肺疾病患者继发真菌感染的研究分析[J].中华医院感染学杂志,2015,25(9):2035-2037.
[19]秦玉梅.慢性阻塞性肺疾病急性加重期患者肺部感染现状及高危因素分析[J].护理实践与研究,2018,15(3):6-8.
[20]Wu Y,Xu H,Li L,et al.Susceptibility to Aspergillus infections in rats with chronic obstructive pulmonary disease via deficiency function of alveolar macrophages and impaired activation of TLR2[J].Inflammation,2016,39(4):1310-1318.
[21]Rohde G,Welte T.Pseudomonas aeruginosainfections in chronic obstructive pulmonary disease:role of long-term antibiotic treatment[J].Internist(Berl),2017,58(11):1142-1149.
[22]钟风芳,冯月娟,陈三峰.氟康唑预防重度慢性阻塞性肺疾病患者真菌感染的效果研究[J].中华医院感染学杂志,2015,25(10):2219-2221.
[23]Mallia P,Webber J,Gill SK,et al.Role of airway glucose in bacterial infections in patients with chronic obstructive pulmonary disease[J].J Allergy Clin Immunol,2018,142(3):815-823.
[24]石卫霞,林英翔,梁立荣,等.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[J].中华医院感染学杂志,2014,24(17):4243-4244,4247.
[25]陈新芝,张亚飞.伊曲康唑在慢性阻塞性肺疾病合并真菌感染治疗的疗效评价[J].临床肺科杂志,2017,22(5):868-870.
[26]玛依拉·阿不都克力木,迪丽努尔·买买提伊明,师帅.慢性阻塞性肺疾病急性加重期患者肺部真菌感染的影响因素研究[J].实用心脑肺血管病杂志,2017,25(5):44-47.
[27]王蕾,毛毅敏,张剑青,等.支气管肺泡灌洗液与血清G试验对AECOPD并发侵袭性肺部真菌感染患者诊断及治疗指导价值分析[J].中华医院感染学杂志,2016,26(22):5116-5118.