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目的:探讨慢性阻塞性肺疾病(COPD)患者继发肺部真菌感染的病原学特征、临床特点、易感因素、诊断防治、治疗和转归。方法:将COPD继发肺部真菌感染患者33例作为观察组,随机抽取同期住院的COPD无真菌感染患者33例作为对照组,对两组的临床疗效、抗生素及糖皮质激素使用情况、住院时间等临床资料进行对比分析。结果:观察组抗生素联用品种多、使用时间长,糖皮质激素使用患者多且使用时间长,住院时间明显延长,与对照组相比差异有统计学意义(P>0.01)。观察组治愈好转率66.7%(22/33),病死率21.2%(7/33),对照组分别为84.4%(28/33)及6.1%(2/33),两组对比差异无统计学意义(P>0.05)。观察组真菌感染的类型主要以白色念珠菌感染为主,占45.5%(15/33),其次为光滑念珠菌及热带念珠菌,分别占18.2%(6/33)及12.1%(4/33)。结论:COPD继发肺部真菌感染率高,抗生素、激素的长期大量应用是常见易感因素,对疑有真菌感染患者应及时、反复做痰涂片或真菌培养,以便早期诊断和治疗。
Objective: To investigate the etiological features, clinical features, predisposing factors, diagnosis, prevention, treatment and prognosis of secondary pulmonary fungal infection in patients with chronic obstructive pulmonary disease (COPD). Methods: Thirty-three patients with COPD secondary to pulmonary fungal infection were selected as the observation group and 33 patients with COPD without fungal infection were randomly selected as the control group. The clinical efficacy, antibiotics and glucocorticoid use, hospital stay Such as clinical data for comparative analysis. Results: There were many antibiotics in the observation group, prolonged use of antibiotics, prolonged use of glucocorticosteroid, prolonged hospitalization, and significant difference compared with the control group (P> 0.01). In the observation group, the cure rate was 66.7% (22/33) and the case fatality rate was 21.2% (7/33) in the control group and 84.4% (28/33) in the control group and 6.1% (2/33) in the control group respectively, with no significant difference between the two groups Significance (P> 0.05). The type of fungal infection in observation group was mainly Candida albicans, accounting for 45.5% (15/33), followed by Candida glabrata and Candida tropicalis, accounting for 18.2% (6/33) and 12.1% (4/33 ). Conclusion: COPD secondary pulmonary fungal infection rate, antibiotics, hormones long-term large-scale use is a common predisposing factor for patients suspected of fungal infections should be timely and repeated sputum smear or fungal culture for early diagnosis and treatment.