慢性阻塞性肺疾病合并肺部真菌感染的临床研究

目的分析慢性阻塞性肺疾病（COPD）患者合并肺部真菌感染的危险因素及免疫状态。方法选择COPD合并真菌感染42例．COPD无合并真菌感染53例，健康人40例作为对照，检测其外周血T淋巴细胞亚群水平并进行比较。COPD患者合并肺部真菌感染的危险因素采用单因素分析。结果真菌感染以白色念珠菌感染为主，COPD合并真菌感染组和COPD无合并真菌感染组CD3和CD4显著低于对照组（P〈0．05），且COPD合并真菌感染组CD3和CD4明显低于COPD无合并真菌感染这样（P〈0．05）。COPD患者合并肺部真菌感染与长期使用广谱抗生素，长期使用糖皮质激素、低蛋白血症、合并糖尿病和合并Ⅱ型呼吸衰竭有关。结论合理使用抗菌药物及糖皮质激素、抗真菌，有效提高机体免疫水平，治疗糖尿病、呼吸衰竭等基础疾病是降低COPD并发肺部真菌感染的重要措施。

Risk factors of Nosocomial Pulmonary Fungal Infection in COPD Patients

Objective To investigate the risk factors and the immune functions for nosocomial pulmonary fungal infection （PFI） in COPD patients. Methods The data of 42 cases ofnosocomial PFI were analyzed to examine the level ofT lymphocyte substs （TLS） in pe- ripheral blood from 53 cases of COPD, and then to compare with 40 healthy donors. Results Nosocomial pulmonary fungal infection was ranked candida albicans as the first pathogen. CD3 and CD4 of COPD with PFI were significantly lower than COPD and heathly donors （P〈 0.05）. According to univariate analysis, the risk factors associated with nosocomial pulmonary fungal infection included those of long term use of broad-spectnma antibiotics, long term use of adrenocortical steroid, diabetes mellitus, type II respiratory failure and hypoalbuminemia. Conclusions The important measures are reasonable use of broad spectrum antibioticsm, corticosteroids and anti-fungal, effective improvemenrf of the immune levels, treatment of basical diseases such as diabetes, respiratory failure and COPD to reduce incidence of pulmonary funsal infection.