老年2型糖尿病合并真菌感染病人的临床特征及预后分析

目的 探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)合并真菌感染病人的临床特征及影响其预后的因素。 方法 选取273例老年T2DM合并真菌感染的病人,按照临床治疗结局分为生存组211例和死亡组62例,对2组病人的临床资料进行回顾性分析。 结果 273例老年病人中共检出295株真菌,其中假丝酵母菌属286株(96.95%),曲霉菌属9株(3.05%);感染途径主要为呼吸道(66.66%)和泌尿道(17.95%)。真菌对抗菌药物的耐药性由高到低依次为伊曲康唑(33.92%)、氟康唑(13.64%)、伏立康唑(6.64%)、5-氟胞嘧啶(1.05%)、两性霉素(0.70%)。多因素Logistic回归分析结果显示,高龄、血糖控制不佳、入住重症监护病房(intensive care unit,ICU)、合并终末期肾病是老年T2DM合并真菌感染病人死亡的独立危险因素(P<0.05)。 结论 对于高龄、血糖控制不佳、入住ICU、合并终末期肾病的T2DM合并真菌感染病人要警惕预后不良的发生,及时进行临床干预,降低病死率。

Analysis of clinical characteristics and prognostic factors in the elderly patients with type 2 diabetes mellitus complicated with fungal infection

Objective To explore the clinical characteristics and prognostic factors in the elderly patients with type 2 diabetes mellitus (T2DM) complicated with fungal infection. Methods A total of 273 elderly patients with T2DM complicated with fungal infection were enrolled. According to the clinical outcomes, the patients were divided into survival group (211 cases) and death group(62 cases). Clinical data of the two groups were analyzed retrospectively. Results A total of 295 strains of pathogens were detected, including 286 strains (96. 95%) of Candida and 9 strains (3. 05%) of Aspergillus. The main routes of infection were the respiratory tract (66. 66%) and urinary tract (17. 95%). The resistance rates of antifungal drugs from high to low were itraconazole (33. 92%), fluconazole (13. 64%), voriconazole (6. 64%), 5-fluorocytosine (1. 05%), amphotericin (0. 70%). Multivariate Logistic regression analysis showed that the indicators such as advanced age, poor glycemic control, hospitalized in ICU and combined with end-stage renal diseases were independent risk factors of death in the elderly patients with T2DM complicated with fungal infection (P<0. 05). Conclusions Patients with advanced age, poor glycemic control, hospitalized in ICU and end-stage renal diseases should be alerted to the occurrence of poor prognosis, and clinical intervention needs to be made in time to reduce the mortality.