2018慢性阻塞性肺疾病急性加重患者并发真菌性肺炎危险因素的研究
[摘要] 目的 探讨慢性阻塞性肺疾病（COPD）患者并发真菌性肺炎的危险因素。 方法 选择2012年1月～2013年12月住院期间并发真菌性肺炎的COPD患者65例为感染组，以同期无真菌性肺炎的COPD住院患者2014例作为对照组，分析COPD并发真菌性肺炎与广谱抗生素种类和疗程、是否联用甲强龙、血清白蛋白水平及APACHE Ⅱ评分等因素的相关性。 结果 感染组广谱抗生素和甲强龙使用时间均明显长于对照组（均P0.05），血清白蛋白水平明显低于对照组（P0.05）。广谱抗生素使用21 d 以上或联用广谱抗生素和甲强龙14 d以上真菌性肺炎发生率均显著升高（P0.05），碳青霉烯类抗生素联用甲强龙14 d以上患者真菌性肺炎发生率显著高于头孢类抗生素或酶抑制剂复合制剂联用甲强龙患者（P0.05）。Logistics回归分析显示，COPD并发真菌性肺炎与广谱抗生素和甲强龙使用时间及低蛋白血症密切相关（均P0.05）。 结论 长时间使用广谱抗生素或甲强龙、联用碳青霉烯类抗生素和甲强龙14 d以上及低蛋白血症是COPD并发真菌性肺炎的独立危险因素。[关键词] 慢性阻塞性肺疾病；真菌性肺炎；广谱抗生素；甲强龙；危险因素
[中图分类号] R447 [文献标识码] A [文章编号] 1673-7210（2014）09（c）-0094-04
Study on risk factors of nosocomial fungal pneumonia in in-patients with acute exacerbation of COPD
YANG Zhongliang1，2 XIA Juan3 YANG Xiuyun4，5▲ HUANG Feihua5 ZHANG Yongjian4 JIANG Zhaohua3
1.Department of Intensive Care Unit， Shanghai Pu'nan Hospital in Pudong New District of Shanghai City， Shanghai 200125， China； 2.Shanghai Blue Cross Research Institute of Medical Science， Shanghai 200125， China； 3.Department of Respiratory Medicine， Shanghai Pu'nan Hospital in Pudong New District of Shanghai City， Shanghai 200125， China； 4.Department of Respiratory Medicine， Haiyan Branch， Tongde Hospital of Zhejiang Province， Haiyan 314300， China； 5.Department of Respiratory Medicine， Tongde Hospital of Zhejiang Province， Hangzhou 310012， China
Objective To explore the probable risk factors of nosocomial fungal pneumonia in in-patients with acute exacerbation of chronic pulmonary obstructive diseases （COPD）. Methods 65 in-patients with acute exacerbation of COPD complicated by nosocomial fungal pneumonia from January 2012 and December 2013 were selected as infection group， while the other 2014 cases of COPD in-patients without fungal pneumonia were selected as control group during the same period. The relationship of the nosocomial fungal pneumonia in COPD patients with the kinds and use duration of broad-spectrum antibacterials， use of prednisolone， serum albumin level， and APACHE Ⅱ scores etc.， were analyzed. Results Both mean use durations of broad-spectrum antibacterials and glucocorticoid in infection group were significantly longer than those in control group （all P0.05）. The mean serum albumin level in infection group was significantly lower than that in control group （P0.05）. The incidence of fungal pneumonia in patients with use duration of broad-spectrum antibacterial over 21 days or combined use of antibacterial and prednisolone over 14 days was significantly increased （P0.05）. Patients with combined use of carbapenems and Prednisolone had higher incidence of fungal pneumonia than those with use of broad-spectrum cefalosporin or -lactamase inhibitor compound in combination with Prednisolone （P0.05）. Logistics regression analysis showed that the nosocomial fungal pneumonia in COPD patients was significantly correlated with the use durations of broad-spectrum antibacterials and Prednisolone， as well as hypoalbuminemia （all P0.05）. Conclusion Longer use durations of broad-spectrum antibacterial or Prednisolone， combined use of carbapenems and Prednisolone over 14 days as well as hypoalbuminemia might be independent risk factors for the nosocomial fungal pneumonia in in-patients with acute exacerbation of COPD.
Chronic pulmonary obstructive diseases； Fungal pneumonia； Broad-spectrum antibacterial； Prednisolone； Risk factor
慢性阻塞性肺疾病（chronic pulmonary obstructive disease，COPD）急性加重是引起COPD发展的重要因素，可导致肺功能急剧下降，严重影响患者的生活质量，是死亡率升高的主要原因之一。近年来，严重COPD患者住院期间并发真菌性肺炎的发病率逐渐上升，但原因不太清楚，尽管进行积极机械通气和抗真菌治疗，病死率仍高达67.0%以上。本研究对呼吸内科住院期间并发真菌性肺炎的COPD患者65例进行回顾性分析，并与同期无真菌性肺炎的2014例COPD住院患者比较，探讨COPD患者并发真菌性肺炎的易感因素，以期为临床COPD患者并发真菌性肺炎的防治提供指导意见。
1 资料与方法
1.1 一般资料
收集2012[(www. ) 专业提供论文代写和发表的服务,欢迎光临]年1月～2013年12月在浙江省立同德医院（及其分院）和上海市浦东新区浦南医院呼吸内科住院期间并发真菌性肺炎的65例COPD患者为感染组，占同期COPD住院患者2079例的3.1%。同期无真菌性肺炎的2014例COPD住院患者作为对照组。排除标准：住院 48 h，合并恶性肿瘤或血液疾病（贫血除外），器官移植，AIDS患者，住院期间进行外科手术患者。两组均为严重程度Ⅲ～Ⅳ级的COPD急性加重期患者。除感染组体重指数低于对照组及糖尿病合并症率高于对照组外，两组患者其他方面差异无统计学意义（P0.05），具有可比性，见表
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