论文部分内容阅读
目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)的危险因素及临床特点。方法收集2012年2月至2015年3月柳州市各医院住院接受治疗的960例COPD患者,其中COPD合并IPA 42例(感染组),剩余918例均为未合并IPA病例(非感染组)。分析COPD合并IPA的相关因素及其临床特点、治疗方法和疗效。结果 (1)单因素分析结果显示:感染组与非感染组在长期应用激素、合并糖尿病、机械通气、应用抗菌药物时间及血清白蛋白水平差异均具有统计学意义(P均<0.01)。(2)经多元Logistic回归分析,影响COPD合并IPA相关因素包括:是否合并糖尿病、血清白蛋白水平及是否长期使用抗菌药物(P<0.05,P<0.01)。(3)感染组咳嗽咳痰、呼吸困难、发热、白细胞较正常升高或降低、C反应蛋白升高、GM实验阳性等临床症状发生率均高于非感染组(P<0.05,P<0.01)。(4)感染组病灶周围“晕征”、单发或者多发空洞、新月征发生率均高于非感染组(P均<0.01)。(5)42例患者分别采用了卡泊芬净与伏立康唑进行治疗,治疗有效率均为83.33%。结论影响COPD合并IPA的相关因素有合并糖尿病、血清白蛋白水平及长期使用抗菌药物,应积极对危险因素加以干预;临床医师应该不断增强对该病的认识,对高危患者,应及时行痰培养、GM实验、胸部CT、病灶活检等检查,以达到尽早诊断,及时治疗,改善预后。
Objective To investigate the risk factors and clinical features of chronic obstructive pulmonary disease (COPD) complicated with invasive pulmonary aspergillosis (IPA). Methods A total of 960 COPD patients admitted to hospitals in Liuzhou City from February 2012 to March 2015 were collected. Among them, 42 patients with COPD complicated with IPA (infection group) and the remaining 918 patients without IPA (non-infected group) were collected. Analysis of COPD with IPA related factors and clinical features, treatment and efficacy. Results (1) The results of univariate analysis showed that there were significant differences in long-term use of hormones, diabetes mellitus, mechanical ventilation, antimicrobial time and serum albumin levels between infected group and non-infected group (all P <0.01). (2) Multivariate Logistic regression analysis showed that the related factors of COPD complicated with IPA include: diabetes mellitus, serum albumin level and long-term use of antimicrobial agents (P <0.05, P <0.01). (3) The incidence of clinical symptoms such as cough and phlegm, dyspnea, fever, leukocyte increased or decreased, C-reactive protein increased and GM test positive in infection group were higher than those in non-infected group (P <0.05, P <0.01) ). (4) In the infected group, the incidence of “halo sign”, single or multiple cavities and crescent sign were higher in non-infected group than those in non-infected group (all P <0.01). (5) 42 patients were treated with caspofungin and voriconazole treatment, the effective rate was 83.33%. Conclusion The related factors affecting COPD complicated with IPA include diabetes mellitus, serum albumin level and long-term use of antimicrobial agents. Intervention should be made for active risk factors. Clinicians should continue to increase their understanding of the disease. In high-risk patients, prompt sputum culture should be performed , GM experiment, chest CT, lesion biopsy and other tests to achieve early diagnosis and timely treatment to improve the prognosis.