本文選題：COPD急性加重　切入點(diǎn)：侵襲性肺曲霉菌病危險(xiǎn)因素　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:研究慢性阻塞性肺疾病(COPD)患者發(fā)生呼吸道曲霉菌分離陽(yáng)性以及發(fā)生侵襲性肺曲霉病(IPA)的危險(xiǎn)因素,對(duì)痰曲霉菌涂片或培養(yǎng)陽(yáng)性結(jié)果在IPA診斷中的作用進(jìn)行再評(píng)價(jià)。方法:選擇2014年1月至2015年1月期間住院治療的慢性阻塞性肺病急性發(fā)作的207名患者中符合條件的95例為研究對(duì)象,其中52例呼吸道曲霉菌分離陽(yáng)性患者,根據(jù)我國(guó)IPA的診斷標(biāo)準(zhǔn)進(jìn)行分組,對(duì)比分析IPA組、非IPA組及痰菌陰性組在基礎(chǔ)疾病、臨床癥狀、既往治療使用的藥物及預(yù)后等方面進(jìn)行回顧性分析。收集所有入選患者的臨床資料,包括年齡、性別、合并疾病(糖尿病、腎功能不全、心功能不全等)、糖皮質(zhì)激素使用情況、廣譜抗生素使用情況、機(jī)械通氣情況、血清白蛋白水平、既往真菌感染或定植史、過(guò)去1年的住院次數(shù)以及抗真菌治療情況和預(yù)后。本研究中將長(zhǎng)期使用糖皮質(zhì)激素界定為全身應(yīng)用相當(dāng)于潑尼松劑量30 mg/d連續(xù)應(yīng)用10 d以上或30 mg/d連續(xù)應(yīng)用1個(gè)月以上。結(jié)果:確診IPA及臨床診斷IPA者25例,曲霉菌定植27例。單因素方差分析發(fā)現(xiàn),長(zhǎng)期使用糖皮質(zhì)激素和廣譜抗生素、機(jī)械通氣、過(guò)去1年中多次住院、低蛋白血癥、既往真菌感染或定植史等因素與COPD患者痰培養(yǎng)陽(yáng)性有關(guān),對(duì)比分析曲霉菌陽(yáng)性患者中IPA與非IPA患者,結(jié)果示長(zhǎng)期使用糖皮質(zhì)激素和廣譜抗生素、機(jī)械通氣、過(guò)去1年中多次住院等因素與COPD患者發(fā)生IPA有關(guān);多因素Logistic回歸分析顯示,長(zhǎng)期使用糖皮質(zhì)激素及過(guò)去一年中多次住院者是AECOPD曲霉菌痰培養(yǎng)陽(yáng)性患者發(fā)生IPA的獨(dú)立危險(xiǎn)因素。IPA組住院病死率為84%,明顯高于定植組22.2%,差異具有統(tǒng)計(jì)學(xué)意(P0.01)。對(duì)預(yù)后危險(xiǎn)因素分析表明,延遲診斷和治療與預(yù)后相關(guān)。將收集到的43例痰曲霉菌培養(yǎng)陰性患者與27例痰曲霉菌培養(yǎng)陽(yáng)性非IPA患者進(jìn)行對(duì)比分析,兩組患者性別、年齡構(gòu)成比、腎功能不全、心功能不全差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而糖尿病、使用激素、長(zhǎng)期使用廣譜抗生素、機(jī)械通氣、過(guò)去1年中多次住院、低蛋白血癥血癥等因素差異有統(tǒng)計(jì)學(xué)意義。(P0.05)結(jié)論:長(zhǎng)期使用糖皮質(zhì)激素或廣譜抗生素、糖尿病、機(jī)械通氣、過(guò)去1年中多次住院、低蛋白血癥、既往真菌感染或定植史是痰曲霉菌培養(yǎng)陽(yáng)性的危險(xiǎn)因素;反復(fù)使用糖皮質(zhì)激素、過(guò)去一年中多次住院是COPD患者發(fā)生IPA的獨(dú)立危險(xiǎn)因素;痰曲霉菌培養(yǎng)陽(yáng)性結(jié)合IPA發(fā)生的高危因素綜合判斷,可以作為IPA早期診斷、搶先抗曲霉治療的依據(jù)。
[Abstract]:Objective: to study the risk factors of respiratory Aspergillus isolation positive and invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD), and to re-evaluate the role of sputum smear or culture positive results in the diagnosis of IPA.Methods: a total of 207 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) hospitalized from January 2014 to January 2015 were selected as subjects, including 52 patients with respiratory aspergillus positive.According to the diagnostic criteria of IPA in China, we compared and analyzed the basic diseases, clinical symptoms, drugs used in previous treatment and prognosis in IPA group, non-#en2# group and sputum negative group.Collect clinical data of all patients, including age, sex, complicated diseases (diabetes, renal insufficiency, cardiac insufficiency, etc.), use of glucocorticoids, use of broad-spectrum antibiotics, mechanical ventilation, etc.Serum albumin level, past fungal infection or colonization history, hospitalization times in the past year, antifungal treatment and prognosis.In this study, the long-term use of glucocorticoid was defined as the whole body application equivalent to prednisone 30 mg/d continuous use for more than 10 days or 30 mg/d continuous use for more than one month.Results: 25 cases of IPA were diagnosed by IPA and 27 cases were colonized by Aspergillus.Univariate analysis of variance showed that long-term use of glucocorticoids and broad-spectrum antibiotics, mechanical ventilation, multiple hospitalizations in the past year, hypoproteinemia, past fungal infection or colonization were associated with positive sputum culture in patients with COPD.The results showed that long-term use of glucocorticoid and broad-spectrum antibiotics, mechanical ventilation and multiple hospitalizations in the past year were associated with IPA in patients with COPD.Long-term use of glucocorticoid and multiple hospitalizations in the past year were independent risk factors for the occurrence of IPA in AECOPD Aspergillus sputum positive patients. The inpatient mortality in IPA group was 84%, which was significantly higher than that in colonization group (22. 2%), and the difference was statistically significant (P 0. 01).Analysis of prognostic risk factors showed that delayed diagnosis and treatment were associated with prognosis.43 sputum Aspergillus culture-negative patients and 27 sputum aspergillus culture-positive non-#en0# patients were compared and analyzed. There was no significant difference in sex, age ratio, renal insufficiency and cardiac insufficiency between the two groups, but there was no significant difference in diabetes mellitus.Use of hormone, long-term use of broad-spectrum antibiotics, mechanical ventilation, in the past year many times in hospital, hypoproteinemia and other factors have statistical significance (P 0.05) conclusion: long-term use of glucocorticoid or broad-spectrum antibiotics, diabetes, mechanical ventilation,In the past year, hypoproteinemia, previous fungal infection or colonization were the risk factors of sputum Aspergillus culture positive, and repeated use of glucocorticoid were independent risk factors for IPA in COPD patients.The comprehensive judgement of the high risk factors of sputum Aspergillus culture combined with the occurrence of IPA can be used as the basis for the early diagnosis of IPA and the preemptive treatment against Aspergillus.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9

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