老年慢性阻塞性肺疾病急性加重期肺部真菌感染的临床分析

目的探讨老年慢性阻塞性肺疾病急性加重期肺部真菌感染的易患因素、临床特征和治疗。方法回顾性调查60岁以上AECOPD合并肺部真菌感染及无肺部真菌感染病例各120例,比较其易患因素,临床特征,实验室及影像学检查。结果所有病例应用广谱抗生素超过2周;80%长期较大剂量使用激素;90%同时合并一种以上慢性疾病,其中以糖尿病、心脑血管疾病、慢性肾病多见;55%合并贫血;71%合并低蛋白血症;66%有粒细胞减少。病原菌主要以酵母菌属为主,占98%。X线以支气管肺炎表现多见(76%)。结论老年AECOPD肺部真菌感染是在自身多种基础疾病的基础上,长期应用广谱抗生素和激素,营养状况差,免疫力低下等条件下继发的一种肺部感染;其临床表现无特异性,死亡率高。

Fungal infection in old people with acute exacerbations of chronic obstructive pulmonary disease

Objective To find out the clinical features,therapeutic outcome and the major predisposing diseases of fungal infection in old people with acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods 120 cases of AECOPD over 60 years old with fungal infection were retrospectively analyzed,comparing with 120 cases without fungal infection.Clinical features,predisposing diseases,laboratory tests and X-ray manifestations were analyzed and calculated.Results Broad-spectrum antibiotics were used in all cases.Large doze of corticosteroids were used in 80% of total cases.One or more predisposing diseases were found in 90% of total cases.Anaemia(55%),hypoalbuminemia(71%),and neutropenia(66%)were found in all of the cases.Monilia ranked the first pathogen(98%).All the clinical manifestation of pulmonary fungal infection were not specific,image features mainly showed bronchitis type(76%).Conclusions Fungal infection in old people with AE-COPD often base on various of predisposing diseases.Long-time usage of antibiotics and corticosteroids,malnutrition and low defensiveness all contribut to the infection.Fungal infection in AECOPD is non-specific and has high mobidity,clinicians should pay more attention to it.