结核重症监护室真菌感染的危险因素分析
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摘要
目的探讨分析重症监护室(ICU)住院肺结核患者真菌感染的危险因素。方法收集2015年1月～2016年9月首都医科大学附属北京胸科医院ICU住院的116例肺结核患者的临床资料,进行回顾性分析,并按照是否合并真菌感染分为真菌组35例及非真菌组81例。采用Logistic回归分析真菌感染的影响因素。结果 116例肺结核患者35例发生真菌感染,发生率为30.17%,单因素分析结果显示,合并糖尿病、肺部其他疾病、咯血、病变范围>3个肺野、空洞、纤维化、应用广谱抗生素>1周、糖皮质激素>1周、侵袭性操作及白蛋白水平等10个因素均与并发肺部真菌感染存在相关性(P <0.05或P <0.01)。Logistic多因素分析结果显示,应用糖皮质激素>1周、广谱抗生素使用>1周、进行侵袭性操作为真菌感染的独立危险因素,而白蛋白水平为真菌感染的保护性因素(P <0.05或P <0.01)。结论 ICU住院肺结核患者真菌感染率高,对于长期应用糖皮质激素、进行侵袭性操作、应用广谱抗生素,低白蛋白水平的患者应警惕真菌感染风险,应及早预防及诊治。
Objective To explore risk factors contributing to fungus infection in severe pulmonary tuberculosis ICU.Methods Clinical data of 116 patients from Beijing Chest Hospital, Capital Medical University from January 2015 to September 2016 were collected and analyzed retrospectively. The patients were divided into fungus infected group 35 cases and non fungus infected group 81 cases. The risk factors contributing to fungus infection were analyzed by Logistic analysis. Results There were 35 cases in the 116 cases were fungus infected and the incidence of fungal infection in tuberculosis patients in the ICU was 30.17%. Single factor analysis showed that 10 factors including complicated with diabetes, other diseases in the lung, hemoptysis, the lung lesion range > 3 pulmonary lobes, cavity, fibrosis, usage of antibiotics and glucocorticoid more than 1 week, traumatic operation and serum albumin level correlated with pulmonary fungal infection(P < 0.05 or P < 0.01). The Logistic regression analysis showed that independent predictive risk factors of fungus infection were usage of glucocorticoid and antibiotics over 1 week, traumatic operation, and serum albumin level was the protect factor(P < 0.05 or P < 0.01). Conclusion Patients with pulmonary tuberculosis in ICU has a higher rate of fungus infection. Patients with long-term glucocorticoids, invasive operations, and using broad-spectrum antibiotics and low albumin level should be aware of the risk of fungal infection, and should take early prevention,diagnosis and treatment.
Objective To explore risk factors contributing to fungus infection in severe pulmonary tuberculosis ICU.Methods Clinical data of 116 patients from Beijing Chest Hospital, Capital Medical University from January 2015 to September 2016 were collected and analyzed retrospectively. The patients were divided into fungus infected group 35 cases and non fungus infected group 81 cases. The risk factors contributing to fungus infection were analyzed by Logistic analysis. Results There were 35 cases in the 116 cases were fungus infected and the incidence of fungal infection in tuberculosis patients in the ICU was 30.17%. Single factor analysis showed that 10 factors including complicated with diabetes, other diseases in the lung, hemoptysis, the lung lesion range > 3 pulmonary lobes, cavity, fibrosis, usage of antibiotics and glucocorticoid more than 1 week, traumatic operation and serum albumin level correlated with pulmonary fungal infection(P < 0.05 or P < 0.01). The Logistic regression analysis showed that independent predictive risk factors of fungus infection were usage of glucocorticoid and antibiotics over 1 week, traumatic operation, and serum albumin level was the protect factor(P < 0.05 or P < 0.01). Conclusion Patients with pulmonary tuberculosis in ICU has a higher rate of fungus infection. Patients with long-term glucocorticoids, invasive operations, and using broad-spectrum antibiotics and low albumin level should be aware of the risk of fungal infection, and should take early prevention,diagnosis and treatment.
引文
[1]沈小波.肺结核合并肺部真菌感染的多因素Logistical回归分析[J].临床肺科杂志,2016,21(11):2095-2097.
[2]中华人民共和国卫生部.肺结核诊断标准(WS288-2008)[S].北京:人民卫生出版社,2008:1-3.
[3]刘同伦.实用结核病学[M].沈阳:辽宁科学技术出版社,1987:284-289.
[4]中华医学会呼吸病学分会感染学组,中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
[5]De Freitas ERS.Profile and severity of the patients of intensive care units:prospective application of the A-PACHEⅡindex[J].Rev Lat Am Enfermagem,2010,18(3):317-323.
[6]Wüthrich M,Deepe GS Jr,Klein B.Adaptive Immunity to Fungi[J].Annu Rev Immunol,2012,30:115-148.
[7]李树民,白碧慧,吴明洋.肺结核并肺部真菌感染患者110例的临床分析[J].中国社区医师,2017,33(23):42,44.
[8]李彦红.肺结核合并下呼吸道感染的病原菌分布及其耐药性[J].中西医结合心血管病电子杂志,2017,5(15):97.
[9]安杰.重症监护室患者侵袭性真菌感染的影响因素[J].广东医学,2014,35(15):2411-2412.
[10]许娟,徐海虹,汪旭明,等.重症监护病房呼吸机相关性肺部真菌感染的危险因素分析[J].中国现代医生,2018,56(5):36-39.(上接第76页)
[11]胡红,刘又宁.糖皮质激素在呼吸疾病治疗中的应用[J].中国实用内科杂志,2013,33(10):764-767.
[12]郝飞,王莉,周村建.糖皮质激素与侵袭性真菌感染[J].中国真菌学杂志,2012,7(6):367-371.
[13]蒋红云.耐多药肺结核患者合并肺部真菌感染的原因分析[J].中国医药指南,2015,13(30):16-18.
[14]曾清.重症监护室的院内肺部真菌感染临床研究[J].中华医院感染学杂志,2002,12(7):488-490.
[15]顾玉虹,王娟,李德宪,等.肺结核并发呼吸衰竭患者死亡的危险因素分析[J].中国慢性病预防与控制,2014,22:555-557.
[16]赵娜,陈虹,陶娟.侵袭性肺部真菌感染危险因素分析[J].西部医学,2012,24(1):21-23.
[17]章涛,宋绍辉,滕维亚.深部真菌感染临床特点及防治对策[J].中华医院感染学杂志,2001,11(6):473-474.
[18]何庭辉,田碧文.综合性中医院ICU医院感染危险因素分析[J].实用医学杂志,2007,23(24):3882-3884.
[19]徐芳,吴凡,王娅南.低蛋白血症对继发型肺结核免疫相关性影响[J].科技通报,2015,31(8):18-20.
[20]辛绍斌.危重症患者肠内外营养作用的对比研究[J].临床肺科杂志,2008,13(5):618-620.
[2]中华人民共和国卫生部.肺结核诊断标准(WS288-2008)[S].北京:人民卫生出版社,2008:1-3.
[3]刘同伦.实用结核病学[M].沈阳:辽宁科学技术出版社,1987:284-289.
[4]中华医学会呼吸病学分会感染学组,中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
[5]De Freitas ERS.Profile and severity of the patients of intensive care units:prospective application of the A-PACHEⅡindex[J].Rev Lat Am Enfermagem,2010,18(3):317-323.
[6]Wüthrich M,Deepe GS Jr,Klein B.Adaptive Immunity to Fungi[J].Annu Rev Immunol,2012,30:115-148.
[7]李树民,白碧慧,吴明洋.肺结核并肺部真菌感染患者110例的临床分析[J].中国社区医师,2017,33(23):42,44.
[8]李彦红.肺结核合并下呼吸道感染的病原菌分布及其耐药性[J].中西医结合心血管病电子杂志,2017,5(15):97.
[9]安杰.重症监护室患者侵袭性真菌感染的影响因素[J].广东医学,2014,35(15):2411-2412.
[10]许娟,徐海虹,汪旭明,等.重症监护病房呼吸机相关性肺部真菌感染的危险因素分析[J].中国现代医生,2018,56(5):36-39.(上接第76页)
[11]胡红,刘又宁.糖皮质激素在呼吸疾病治疗中的应用[J].中国实用内科杂志,2013,33(10):764-767.
[12]郝飞,王莉,周村建.糖皮质激素与侵袭性真菌感染[J].中国真菌学杂志,2012,7(6):367-371.
[13]蒋红云.耐多药肺结核患者合并肺部真菌感染的原因分析[J].中国医药指南,2015,13(30):16-18.
[14]曾清.重症监护室的院内肺部真菌感染临床研究[J].中华医院感染学杂志,2002,12(7):488-490.
[15]顾玉虹,王娟,李德宪,等.肺结核并发呼吸衰竭患者死亡的危险因素分析[J].中国慢性病预防与控制,2014,22:555-557.
[16]赵娜,陈虹,陶娟.侵袭性肺部真菌感染危险因素分析[J].西部医学,2012,24(1):21-23.
[17]章涛,宋绍辉,滕维亚.深部真菌感染临床特点及防治对策[J].中华医院感染学杂志,2001,11(6):473-474.
[18]何庭辉,田碧文.综合性中医院ICU医院感染危险因素分析[J].实用医学杂志,2007,23(24):3882-3884.
[19]徐芳,吴凡,王娅南.低蛋白血症对继发型肺结核免疫相关性影响[J].科技通报,2015,31(8):18-20.
[20]辛绍斌.危重症患者肠内外营养作用的对比研究[J].临床肺科杂志,2008,13(5):618-620.