摘要
目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者合并侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)的影响因素,以指导临床合理预防对策的制定。方法回顾性收集2020年1月—2024年11月宁夏医科大学总医院收治的53例COPD合并IPA患者的临床资料作为研究组,53例COPD未合并IPA患者的临床资料作为对照组。分析研究组患者微生物学检查结果,比较两组一般情况、实验室检查资料、临床表现及胸部CT表现,予以多因素logistic回归分析COPD患者合并IPA的危险因素。结果53例COPD合并IPA患者中,1例经肺组织穿刺病理学检出曲霉菌丝,微生物培养烟曲霉阳性确诊,其余52例均为临床诊断。53例COPD合并IPA患者微生物培养出致病菌53株,其中烟曲霉35株(66.04%)、黑曲霉6株(11.32%)、黄曲霉6株(11.32%)、米曲霉4株(7.55%)、土曲霉2株(3.77%)。研究组合并糖尿病、有低白蛋白血症、全身使用激素、使用抗菌药物种类≥3种、使用抗菌药物时间≥14 d、有侵入性操作、住院时间≥14 d、发热、咯血及晕轮征、结节影、空洞占比高于对照组(P<0.05)。多因素logistic回归分析结果显示,合并糖尿病(OR=3.080)、有低白蛋白血症(OR=2.630)、全身使用激素(OR=3.108)、使用抗菌药物种类≥3种(OR=2.210)、使用抗菌药物时间≥14 d(OR=1.929)、有侵入性操作(OR=2.421)、住院时间≥14 d(OR=2.793)均是COPD患者合并IPA的危险因素(P<0.05)。结论COPD合并IPA患者主要致病菌为烟曲霉,且其发生与合并糖尿病、有低白蛋白血症、全身使用激素、使用抗菌药物种类≥3种、使用抗菌药物时间≥14 d、有侵入性操作及住院时间≥14 d密切相关,临床可据此制定合理预防对策,以降低COPD患者发生IPA的风险。
Objective To investigate the influencing factors of combined invasive pulmonary aspergillosis(IPA)in patients with chronic obstructive pulmonary disease(COPD),in order to guide the development of clinically rational preventive countermeasures.Methods The clinical data of 53 patients with COPD combined with IPA admitted to General Hospital of Ningxia Medical University from January 2020 to November 2024 were retrospectively collected as the study group,and the clinical data of 53 patients with COPD not combined with IPA were collected as the control group.The microbiological examination results of the patients in the study group were analyzed,the general conditions,laboratory examination data,clinical manifestations and chest CT manifestations of the two groups were compared,and the risk factors of IPA in COPD patients were analyzed by multifactorial logistic regression.Results Among the 53 patients with COPD combined with IPA,Aspergillus filaments was detected in one case by lung tissue puncture pathology and the diagnosis was confirmed by positive microbiological culture of Aspergillus fumigatus.The remaining 52 cases were diagnosed clinically.Microbiological culture of 53 cases of COPD combined with IPA revealed 53 fungal strains,including 35 isolates of Aspergillus fumigatus(66.04%),6 isolates of Aspergillus niger(11.32%),6 isolates of Aspergillus flavus(11.32%),4 isolates of Aspergillus oryzae(7.55%)and 2 isolates of Aspergillus terreus(3.77%).The study group had a higher percentage of combination of diabetes mellitus,having hypoalbuminemia,systemic use of hormones,using≥3 types of antimicrobial drugs,using antimicrobial drugs for≥14 d,having invasive operations,having a hospitalization time of≥14 d,fever,hemoptysis,and corona sign,nodular shadow,and cavitation(P<0.05).Multifactorial logistic regression analysis showed that the combination of diabetes mellitus(OR=3.080),having hypoalbuminemia(OR=2.630),systemic use of hormones(OR=3.108),using≥3 types of antimicrobial drugs(OR=2.210),using antimicrobial drugs for≥14 d(OR=1.929),having invasive operation(OR=2.421),and hospitalization time≥14 d(OR=2.793)were all risk factors for comorbid IPA in patients with COPD(P<0.05).Conclusion The main causative organism in patients with COPD combined with IPA was Aspergillus fumigatus,and its occurrence were closely related to the combination of diabetes mellitus,having hypoalbuminemia,systemic use of hormones,using≥3 types of antimicrobial drugs,using antimicrobial drugs for≥14 d,having invasive operations,having a hospitalization time of≥14 d.Clinics could formulate reasonable preventive countermeasures accordingly to reduce the risk of IPA in patients with COPD.
作者
勉睿清
张明慧
乔立娇
王红红
王晶
MIAN Ruiqing;ZHANG Minghui;QIAO Lijiao;WANG Honghong;WANG Jing(Department Pathology,Ningxia Medical University General Hospital,Yinchuan 750001,China;Oncology Department 2,Ningxia Medical University General Hospital,Yinchuan 750001,China;Department Pathology,Ningxia Hui Autonomous Region People’s Hospital,Yinchuan 750001,China)
出处
《中国真菌学杂志》
2025年第6期610-616,共7页
Chinese Journal of Mycology
基金
宁夏科技厅项目-宁夏自然科学基金项目(2022AAC03596)。
关键词
慢性阻塞性肺疾病
侵袭性肺曲霉病
影响因素
预防对策
chronic obstructive pulmonary disease
invasive pulmonary aspergillosis
influencing factors
preventive measures
