發(fā)布時(shí)間：2018-05-03 10:22

  本文選題：慢性阻塞性肺疾病 + 侵襲性肺曲霉菌病��； 參考：《中國(guó)臨床研究》2016年07期

【摘要】：目的探討慢性阻塞性肺疾病(COPD)合并侵襲性肺曲霉菌病(IPA)的危險(xiǎn)因素及臨床特點(diǎn)。方法收集2012年2月至2015年3月柳州市各醫(yī)院住院接受治療的960例COPD患者,其中COPD合并IPA 42例(感染組),剩余918例均為未合并IPA病例(非感染組)。分析COPD合并IPA的相關(guān)因素及其臨床特點(diǎn)、治療方法和療效。結(jié)果 (1)單因素分析結(jié)果顯示:感染組與非感染組在長(zhǎng)期應(yīng)用激素、合并糖尿病、機(jī)械通氣、應(yīng)用抗菌藥物時(shí)間及血清白蛋白水平差異均具有統(tǒng)計(jì)學(xué)意義(P均0.01)。(2)經(jīng)多元Logistic回歸分析,影響COPD合并IPA相關(guān)因素包括:是否合并糖尿病、血清白蛋白水平及是否長(zhǎng)期使用抗菌藥物(P0.05,P0.01)。(3)感染組咳嗽咳痰、呼吸困難、發(fā)熱、白細(xì)胞較正常升高或降低、C反應(yīng)蛋白升高、GM實(shí)驗(yàn)陽(yáng)性等臨床癥狀發(fā)生率均高于非感染組(P0.05,P0.01)。(4)感染組病灶周?chē)?暈征"、單發(fā)或者多發(fā)空洞、新月征發(fā)生率均高于非感染組(P均0.01)。(5)42例患者分別采用了卡泊芬凈與伏立康唑進(jìn)行治療,治療有效率均為83.33%。結(jié)論影響COPD合并IPA的相關(guān)因素有合并糖尿病、血清白蛋白水平及長(zhǎng)期使用抗菌藥物,應(yīng)積極對(duì)危險(xiǎn)因素加以干預(yù);臨床醫(yī)師應(yīng)該不斷增強(qiáng)對(duì)該病的認(rèn)識(shí),對(duì)高�；颊�,應(yīng)及時(shí)行痰培養(yǎng)、GM實(shí)驗(yàn)、胸部CT、病灶活檢等檢查,以達(dá)到盡早診斷,及時(shí)治療,改善預(yù)后。
[Abstract]:Objective to investigate the risk factors and clinical features of chronic obstructive pulmonary disease (cad) with invasive pulmonary aspergillosis (IPA). Methods from February 2012 to March 2015, 960 patients with COPD were enrolled in the hospital in Liuzhou, 42 of them were COPD combined with IPA (infection group), the remaining 918 cases were uncomplicated IPA cases (non-infection group). To analyze the related factors, clinical characteristics, treatment methods and curative effect of COPD complicated with IPA. Results 1) the results of univariate analysis showed that: the infection group and the non-infection group were treated with hormone for a long time, complicated with diabetes, mechanical ventilation, There were statistically significant differences in the time of antibiotics and serum albumin levels (P < 0.01) by multivariate Logistic regression analysis, the factors related to COPD and IPA were as follows: diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus and diabetes mellitus. Serum albumin level and whether long-term use of antimicrobial agents P0.05, P0.01P0.01P0.01An) infection group cough expectoration, dyspnea, fever, The incidence of clinical symptoms, such as elevated or lower levels of leukocytes in patients with higher or lower levels of C reactive protein and positive GM test, was higher than that in the non-infected group (P0.05, P0.01P0.01P0.01P0.01U. 4) the "halo sign", single or multiple cavity, around the lesion in the infected group. The incidence rate of crescent sign was higher than that of non-infection group (P = 0.01). 542 patients were treated with carpofen and voleconazole respectively. The effective rate was 83.33. Conclusion the related factors affecting COPD complicated with IPA are diabetes mellitus, serum albumin level and long-term use of antimicrobial agents, which should be actively interfered with risk factors, and the clinicians should constantly enhance their understanding of the disease and treat high risk patients. In order to make early diagnosis, timely treatment and improve prognosis, we should do the GM test of sputum culture, chest CTS and biopsy in time.
【作者單位】： 廣西科技大學(xué)第一附屬醫(yī)院呼吸科;
【基金】：廣西壯族自治區(qū)衛(wèi)生廳科研課題(z2012605)
【分類(lèi)號(hào)】：R563.9;R519

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本文編號(hào)：1838115