基于循证医学方法研究儿童肺部侵袭性真菌感染的危险因素

目的系统分析儿童侵袭性肺部真菌感染的相关危险因素,为临床治疗和感染管理提供循证医学证据。方法检索PubMed、Embase、CochraneLibrary、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库以及维普信息资源系统(VIP)等数据库,收集儿童侵袭性真菌感染危险因素的临床对照研究,检索年限为2000年1月-2018年12月,按照NOS标准评价纳入研究的质量,meta分析提取数据。结果纳入8个研究,7203例患者,真菌感染组648例,非侵袭性真菌感染组6555例。Meta分析显示,侵袭性真菌感染组的抗菌药物用药时间(MD=2.14,95%CI=1.42~2.87,P<0.001)和糖皮质激素用药时间(MD=1.60,95%CI=1.17~2.03,P<0.001)大于非真菌感染组,真菌感染组的危重病评分<70分(OR=3.18,95%CI=2.58~3.93,P<0.001)、抗菌药物用药时间>14d(OR=3.22,95%CI=2.58~4.02,P<0.001)、糖皮质激素用药时间>7 d(OR=7.81,95%CI=5.63~10.83,P<0.001)、有创机械通气(OR=7.28,95%CI=4.72~11.21,P<0.001)、体内留置导管(OR=2.55,95%CI=2.06~3.14,P<0.001)、营养不良(OR=4.63,95%CI=3.11~6.91,P<0.001)及腹泻(OR=4.37,95%CI=3.38~5.65,P<0.001)的构成比大于非侵袭性真菌感染组。结论按照关联强度,儿童侵袭性肺部真菌感染的危险因素依次为糖皮质激素用药时间>7 d、有创机械通气、营养不良、腹泻、抗菌药物用药时间>14 d、危重病评分<70分和体内留置导管。

Study on Risk Factors of Invasive Fungal Infection of Lung in Children Based on Evidence-based Medicine

OBJECTIVE To evaluate the risk factors for invasive fungal infection(IFI) of lung in children, to provide evidence-based medical evidence for clinical treatment and infection management. METHODS Searched databases such as PubMed, Embase, Cochrane Library, CNKI, CMB, VIP and Wanfang database, and collected the randomized controlled trial (RCT) of risk factors for IFI in children from Jan. 2000 to Sep. 2018. The quality of the literature which was enrolled into the meta-analysis evaluated by Newcastle-Ottawa Quality Assessment Scale(NOS), and then meta-analysis was conducted by RevMan 5.2 software. RESULTS Total of 8 studies involving 7 203 patients were entered, 648 patients in IFI group and 6 555 patients in non-IFI group. Meta-analysis showed that antibiotics administration time(MD=2.14, 95% CI=1.42-2.87, P<0.001) and glucocorticoid administration time(MD=1.60, 95% CI=1.17-2.03, P<0.001) in IFI group were all significantly greater than that in the non-IFI group. The composition ratio of critical illness score <70 points(OR=3.18, 95%CI=2.58-3.93, P<0.001), antibiotic medication time >14 d(OR=3.22, 95%CI=2.58-4.02, P<0.001), glucocorticoid administration time >7 d(OR=7.81, 95%CI=5.63 10.83, P<0.001), invasive mechanical ventilation(OR=7.28, 95% CI=4.72-11.21, P<0.001), indwelling catheters (OR=2.55, 95% CI=2.06-3.14, P<0.001), malnutrition(OR=4.63, 95% CI=3.11-6.91, P<0.001) and diarrhea(OR=4.37, 95% CI=3.38-5.65, P<0.001) in IFI group were all significantly greater than that in the non-IFI group. CONCLUSION According to the strength of association, the risk factors for invasive pulmonary fungal infection in children are glucocorticoid administration time >7 d, invasive mechanical ventilation, malnutrition, diarrhea, antibiotic medication time >14 d, critical illness score <70 points and indwelling catheters.