结缔组织病患者念珠菌深部定植的危险因素分析

目的 了解结缔组织病患者念珠菌深部定植的发生率及相关危险因素.方法 对153例结缔组织病患者和63例健康人的咽拭、中段尿、肛拭标本进行真菌培养,采用Logistic相关回归分析模型,对患者念珠菌深部定植的危险因素进行相关性分析.结果 患者组的念珠菌深部定植率35.29%显著高于健康人组7.94%,菌种分析以白念珠菌最常见.患者组血红细胞计数降低,尿蛋白增多,血清补体(CH50、C3、C4)水平降低,糖皮质激素使用每日均量较高以及广谱抗生素使用与结缔组织病患者念珠菌深部定植有显著相关性;而性别、年龄、身高、体质量、病程、有结缔组织病家族史、既往脏器损害、血白细胞及中性粒细胞计数低下、血小板计数低下、尿红细胞与白细胞异常增多、糖皮质激素使用总量与疗程、某些免疫抑制剂(环磷酰胺、硫唑嘌呤等)的使用、雷公藤的使用总量与疗程、窄谱抗生素的使用等与结缔组织病患者念珠菌深部定植无显著相关性.结论 结缔组织病患者念珠菌深部定植率显著高于健康人,控制相关危险因素将减少念珠菌深部定植的发生.

The risk factors of deep candidal colonization in patients with connective tissue diseases

Objective To investigate the incidence of candidal colonization and to analyze its risk factors in patients with connective tissue diseases (CTDs). Methods Throat swabs, midstream urine and anal swabs from 153 patients with CTDs and 63 healthy volunteers were collected for fungus culture. The logistic regression was completed via the software package SPSS 11.0. Results The incidence rate of candidal colonization was higher in the patients than that in the healthy controls (35.29% vs 7.59%). Of all the isolated fungus strains, the proportion of Candida albicans was the highest. The logistic regression analysis revealed that decrease of blood erythrocytes, increase of urine protein, decrease of complements such as CH50, C3 and C4 in serum, high daily dosage of corticosteroids and broad-spectrum antibiotic administration all significantly increased the risk of candidal colonization (all P < 0.05). No correlation was found between candidal colonization and any of the following factors: sex, age, height, weight, disease course, family history of connective tissue disease, previous involvement of internal organs, leukocytopenia, granulocytopenia, thrombocytopenia, increase of urine erythrocytes or leukocytes, decrease of total dose and therapeutic course of corticosteroids, administration of some immunosuppressants such as cyclophosphamide or azathiopurine, total dose and therapeutic course of Tripterygium wilfordii and administration of narrow-spectrum antibiotics(all P > 0.05). Conclusions The incidence rate of candidal colonization in patients with CTDs is higher than that in healthy controls. Avoiding the risk factors will help to decrease the incidence of candidal colonization in CTDs.