首页|111例侵袭性肺曲霉病(IPA)的临床特征及预后风险因素

111例侵袭性肺曲霉病(IPA)的临床特征及预后风险因素

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目的 探讨侵袭性肺曲霉病(IPA)的临床特征、实验室检查及预后风险因素。方法 回顾性分析2020年9月—2023年6月某院IPA患者的临床资料,分析其临床特征及预后风险因素。结果 共纳入111例IPA患者,年龄为(68。8±12。5)岁,以男性为主(63。1%),主要分布于呼吸科、重症监护病房(ICU)、血液科及感染科,共占75。6%。IPA常见的曲霉为烟曲霉、黄曲霉及黑曲霉,分别占67。6%、19。8%、4。5%。支气管肺泡灌洗液的(1,3)-β-D-葡聚糖抗原检测(G试验)、半乳甘露聚糖抗原检测(GM试验)阳性率分别为73。7%、68。0%。111例IPA患者中,32例(28。8%)随访发现预后不良,25例(22。5%)合并病毒感染。logistic多因素回归分析显示,合并病毒感染[OR(95%CI):4。535(1。385~14。846),P=0。012]、连续 3 周使用糖皮质激素史[OR(95%CI):9。128(2。293~36。341),P=0。002]、机械通气[OR(95%CI):4。690(1。100~19。990),P=0。037]及留置导尿管[OR(95%CI):7。144(1。345~37。950),P=0。021]是IPA患者预后不良的独立危险因素。结论 多种因素与IPA预后不良有关,应联合多种检测手段早期识别并尽早给予合理治疗,以改善患者预后,同时需采取相应预防措施,避免出现医院感染。
Clinical characteristics and prognostic risk factors of 111 cases of invasive pulmonary aspergillosis
Objective To explore the clinical characteristics,laboratory examination and prognostic risk factors of invasive pulmonary aspergillosis(IPA).Methods Clinical data of IP A patients in a hospital from September 2020 to June 2023 were retrospectively analyzed.Clinical characteristics and prognostic risk factors of patients were ana-lyzed.Results A total of 111 patients with IPA were analyzed,aged(68.8±12.5)years old,mainly male(63.1%),and were mainly distributed in the department of respiratory diseases,intensive care unit(ICU),departments of he-matology and infectious diseases,accounting for 75.6%in total.The common Aspergillus in IPA were Aspergillus fumigatusi Aspergillus flavus and Aspergillus niger,accounting for 67.6%,19.8%and 4.5%respectively.The positive rates of(1,3)-β-D-glucan antigen test(G test)and galactomannan antigen test(GM test)for bronchoalveo-lar lavage fluid(BALF)were 73.7%and 68.0%,respectively.Of 111 IPA patients,32(28.8%)had poor prog-nosis and 25(22.5%)were complicated with viral infection.Multivariate logistic regression analysis showed that combined with viral infection(OR[95%CI]:4.535[1.385-14.846],P=0.012),glucocorticoid use history for 3 consecutive weeks(OR[95%CI]:9.128[2.293-36.341],P=0.002),mechanical ventilation(OR[95%CI]:4.690[1.100-19.990],P=0.037)and indwelling urinary catheter(OR[95%CI]:7.144[1.345-37.950],P=0.021)were independent risk factors for poor prognosis in IPA patients.Conclusion Multiple factors are related to the poor prognosis of IPA,and multiple methods should be combined to perform early identification and rational treatment for improving patient prognosis,corresponding preventive measures should be taken to avoid the occur-rence of healthcare-associated infection.

pulmonary aspergillosisIPAclinical characteristicprognostic risk factor

叶乃芳、龚真、唐伟、李昕、储雯雯、刘周、周强

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安徽医科大学第二附属医院检验科,安徽合肥 230601

肺曲霉病 IPA 临床特征 预后风险因素

安徽医科大学青年自然科学基金安徽省高等学校自然科学研究项目

2020xkj031KJ2021ZD0029

2024

中国感染控制杂志
中南大学

中国感染控制杂志

CSTPCD北大核心
影响因子:2.112
ISSN:1671-9638
年,卷(期):2024.23(4)
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