摘要
目的 探究特发性炎性肌病(IIM)间质性肺炎(IP)患者肺部感染的病原学特征及危险因素.方法 将2019年12月—2023年4月南阳市中心医院收治的95例IIM IP患者发生与未发生肺部感染的临床资料分别纳入感染组(n=52)和非感染组(n=43).统计IIM IP患者肺部感染的现况及病原学特征,通过单因素及多因素分析法分析IIM IP患者肺部感染的危险因素.结果 95例IIM IP患者有52例发生肺部感染,肺部感染发生率为54.74％;共分离59株病原菌,其中革兰阴性菌、革兰阳性菌、真菌、巨细胞病毒和肺炎支原体占比分别为45.76％、28.81％、20.34％、3.39％、1.69％,革兰阴性菌以铜绿假单胞菌(11株)为主,革兰阳性菌以肺炎链球菌(7株)为主;多因素Logistic回归分析结果显示,外周血淋巴细胞计数、CD4+/CD8+及血清白蛋白、乳酸脱氢酶(LDH)是IIM IP患者肺部感染的危险因素(P＜0.05).结论 IIM IP患者肺部感染的发生率高,且病原菌以革兰阴性菌为主;IIM IP患者肺部感染与外周血淋巴细胞计数、CD4+/CD8+、白蛋白、LDH关系密切;临床可据此予以早期针对性防治从而降低IIM IP患者肺部感染的发生风险.
Abstract
OBJECTIVE To explore the etiological characteristics and risk factors of pulmonary infection in patients with idiopathic inflammatory myopathy(IIM)associated interstitial pneumonia(IIP).METHODS The 95 IIM-IIP patients with and without pulmonary infection treated in Nanyang Central Hospital from Dec 2019 to Apr 2023 were assigned as the infected group(n=52)and non-infected group(n=43),respectively.The status and etio-logical characteristics of pulmonary infection in patients with IIM-IIP were analyzed.The risk factors of pulmonary infection in patients with IIM-IIP were analyzed by univairate and multivariate analysis.RESULTS Among 95 IIM-IIP patients,52 cases had pulmonary infection,the incidence of pulmonary infection was 54.74％.A total of 59 strains of pathogenic bacteria were isolated,among which the proportion of gram-negative bacteria,gram-positive bacteria,fungi,cytomegalovirus and mycoplasma pneumoniae were 45.76％,28.81％,20.34％,3.39％,1.69％,respectively.Gram-negative bacteria were mainly Pseudmonas aeruginosa(11 strains),gram-positive bacteria were mainly Streptococcus pneumoniae(7 strains).Multivariate logistic regression analysis showed that peripheral blood lymphocyte count,CD4+/CD8+,serum albumin,lactate dehydrogenase(LDH)were risk factors for pul-monary infection in patients with IIM-IIP(P＜0.05).CONCLUSION The incidence of pulmonary infection in pa-tients with IIM-IIP is high,and the pathogenic bacteria are mainly gram-negative bacteria.Pulmonary infection in IIM-IIP patients is closely related to peripheral blood lymphocyte count,CD4+/CD8+,albumin and LDH.Therefore,early targeted prevention and treatment should be used to reduce the risk for pulmonary infection in patients with IIM-IIP.
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