慢性阻塞性肺疾病继发肺部真菌感染56例临床分析

目的 探讨慢性阻塞性肺疾病（COPD）患者继发肺部真菌感染的临床特点及危险因素.方法 回顾性分析296例COPD患者的临床资料,其中56例继发肺部真菌感染为感染组,未发生真菌感染240例为非感染组.分析比较两组患者使用抗生素种类、抗生素应用疗程,以及应用激素情况;低蛋白血症、侵入性操作、死亡例数情况.通过痰涂片培养结果确定真菌种类.结果 感染组病死率16.1％（9/56）明显高于非感染组6.2％ （15/240）,差异有统计学意义（x2=6.436,P＜0.05）;感染组使用抗生素种类（2.6±0.8）种、应用抗生素疗程（15.4±2.6）d、应用激素比例41.1％ （23/56）]、低蛋白血症比例57.1％ （32/56）]、侵入性操作比例35.7％ （20/56）]均大于非感染组（1.6±0.6）种、（9.6±2.2）d、8.3％ （20/240）、12.1％（29/240）、5.4％ （13/240）],差异有统计学意义（P均＜0.05）;非感染组治疗总有效率90.4％ （217/240）高于感染组78.6％ （44/56）,差异有统计学意义（x2=4.248,P＜0.05）.感染组真菌感染种类主要以白色念珠菌为主.结论 长期使用高档抗生素、应用激素、低蛋白血症及侵入性操作是引起COPD继发真菌感染的主要因素.在抗真菌治疗中,主要针对病原菌治疗,根据痰培养结果选择抗真菌药物.

Clinical analysis of 56 cases with secondary fungal infection with chronic obstructive pulmonary disease

Objective To figure out clinical characteristics and risk factors of secondary fungal infection in patients with chronic obstructive pulmonary disease（COPD）.Methods Two hundred and ninetysix patients with COPD were enrolled in our study who were treated in the People＇s Hospital of Liaocheng.Of whom,56 cases with secondary fungal infection were served as infection group and other 240 cases were non infection group.The clinical data including sorts of antibiotics,the therapy periods of antibiotic,hormones,hypoalbuminemia,invasive operation and death cases were recorded.Sort of fungal were determined by sputum culture.Results Mortality of infection group was 16.1% （9/56）,obviously higher than that of the noninfected group （6.2% （15/240）） and the difference was significant（x2 =6.436,P 〈0.05）.The average sorts of antibiotic,the therapy periods of antibiotic,rate of hormones,the rate of hypoalbuminemia,rate of were invasive operation in infection group were （2.6 ±0.8）,（15.4 ±2.6） d,41.1% （23/56）,57.5% （32/56）,35.7% （20/56）,higher than those in non infection group（1.6 ±0.6,（9.6 ±2.2） d,8.3% （20/240）,12.1% （29/240）,5.4% （13/240） ; P 〈 0.05）.The total efficacy rate in non infection group was 90.4% （217/240）,higher than that in infection group （78.6% （44/56））,and the difference was significant （x2 =4.248,P 〈 0.05）.The majority sort of fungal in infection group was monilia albicans.Conclusion The main risk factors of secondary fungal infection in patients with COPD include long-term using high-end application antibiotics,hormones,hypealbuminemia and invasive operation.The therapy on fungi is focused on pathogen treatment such as anti-fungal drug therapy.